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General NPI Number Information
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NPI Number | 1740014505
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Entity Type | Organization
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Legal Business Name | PURE HOPE WEIGHT LOSS AND HEALTHCARE, LLC
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Dates
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Enumeration Date | 08/26/2024
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 145 HILDEN RD STE 123
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City | PONTE VEDRA
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State | FL
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Zip | 32081-8403
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Country | US
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Telephone | 904-815-8353
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Fax |
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Provider Business Mailing Address
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Address Line | 155 BARTRAM MARKET DR STE 135-185
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City | SAINT JOHNS
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State | FL
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Zip | 32259-4581
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Country | US
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Telephone | 904-815-8353
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Fax | 904-295-3947
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | MRS. AMANDA HOLT
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Credential | AUTONOMOUS APRN, FNP
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Telephone | 904-815-8353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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