=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568267144
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDEN HEALTH PRACTITIONERS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2025
-----------------------------------------------------
Last Update Date | 05/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 180 PINNACLES DR STE 201
-----------------------------------------------------
City | PALM COAST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32164-2597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-325-9585
-----------------------------------------------------
Fax | 386-310-0613
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 WEYANOKE LN
-----------------------------------------------------
City | PALM COAST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32164-4055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-514-6368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | ELIZABETH M ACLOQUE
-----------------------------------------------------
Credential | APRN, FNP-BC
-----------------------------------------------------
Telephone | 860-514-6368
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------