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1740174473 NPI number — NOVA WELLNESS LOFT LLC

NPI Number: 1740174473
Health Care Provider/Practitioner: NOVA WELLNESS LOFT LLC

Information about “1740174473” NPI (NOVA WELLNESS LOFT LLC) exists in 1740174473 in HTML format HTML  |  1740174473 in plain Text format TXT  |  1740174473 in PDF (Portable Document Format) PDF  |  1740174473 in an XML format XML  formats.

NPI Number : 1740174473 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1740174473",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "NOVA WELLNESS LOFT LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1 SOUTH BLVD E # 1845",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DAVENPORT",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33837-7547",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2320 NORTH BLVD W STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DAVENPORT",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33837-8961",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "863-866-0909",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/06/2025",
    "LastUpdateDate": "06/06/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DOMINIQUE-MERVEUS",
    "AuthorizedOfficialFirstName": "YASMINE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CO-OWNER",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LCSW",
    "AuthorizedOfficialTelephoneNumber": "863-866-0909",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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