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General NPI Number Information
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NPI Number | 1629943311
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Entity Type | Organization
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Legal Business Name | MOXIE WELLNESS CENTER LLC
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Dates
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Enumeration Date | 10/10/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 12515 ORANGE DR STE 803
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City | DAVIE
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State | FL
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Zip | 33330-4309
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Country | US
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Telephone | 786-975-6993
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Fax | 954-405-8541
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Provider Business Mailing Address
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Address Line | 12515 ORANGE DR STE 803
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City | DAVIE
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State | FL
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Zip | 33330-4309
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Country | US
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Telephone | 786-975-6993
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Fax | 954-405-8541
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Authorized Official
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Title or Position | APRN/OWNER
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Name | YULEISY COTO
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Credential | FNP-C
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Telephone | 786-975-6993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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