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General NPI Number Information
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NPI Number | 1609270925
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Entity Type | Organization
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Legal Business Name | JOYFUL JUICING
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 1035 COLLIER CENTER WAY STE 10
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City | NAPLES
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State | FL
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Zip | 34110-8474
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Country | US
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Telephone | 239-908-6879
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Fax |
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Provider Business Mailing Address
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Address Line | 1035 COLLIER CENTER WAY STE 10
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City | NAPLES
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State | FL
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Zip | 34110-8474
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Country | US
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Telephone | 239-908-6879
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | HANNAH PETERSON
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Credential |
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Telephone | 561-281-4802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | L14000103803
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License Number State | FL
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