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General NPI Number Information
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NPI Number | 1619632643
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Entity Type | Organization
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Legal Business Name | PURE WELLNESS & AESTHETICS, LLC
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 733 TERRANOVA AVE
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City | WINTER HAVEN
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State | FL
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Zip | 33884-3411
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Country | US
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Telephone | 863-221-5566
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1435
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City | WINTER HAVEN
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State | FL
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Zip | 33882-1435
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | NACRESHA NICOLE RICHARDSON
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Credential | APRN
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Telephone | 863-288-1709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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