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General NPI Number Information
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NPI Number | 1669336764
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Entity Type | Organization
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Legal Business Name | FABULOUSLY MADE SALON, LLC
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 8909 REGENTS PARK DR STE 415
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City | TAMPA
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State | FL
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Zip | 33647-3432
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Country | US
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Telephone | 813-444-3229
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Fax |
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Provider Business Mailing Address
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Address Line | 8909 REGENTS PARK DR STE 415
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City | TAMPA
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State | FL
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Zip | 33647-3432
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Country | US
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Telephone | 813-444-3229
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHANNA Y AMARANTE
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Credential |
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Telephone | 813-444-3229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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