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General NPI Number Information
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NPI Number | 1669265815
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Entity Type | Organization
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Legal Business Name | SERENITY SHIFT WELLNESS CENTER INC
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 2450 HOLLYWOOD BLVD STE 701
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City | HOLLYWOOD
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State | FL
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Zip | 33020-6628
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Country | US
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Telephone | 786-226-2679
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Fax | 954-416-7437
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Provider Business Mailing Address
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Address Line | 2450 HOLLYWOOD BLVD STE 701
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City | HOLLYWOOD
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State | FL
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Zip | 33020-6628
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Country | US
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Telephone | 786-226-2679
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Fax | 954-416-7437
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Authorized Official
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Title or Position | APRN, OWNER
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Name | MRS. STEPHANIE CORBO
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Credential | APRN
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Telephone | 469-638-3162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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Taxonomy #5
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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Taxonomy #6
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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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