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General NPI Number Information
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NPI Number | 1811861511
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Entity Type | Organization
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Legal Business Name | PURE SERENITY MENTAL WELLNESS LLC
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Dates
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Enumeration Date | 10/03/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 1489 W PALMETTO PARK RD
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City | BOCA RATON
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State | FL
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Zip | 33486-3325
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Country | US
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Telephone | 941-281-4038
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Fax |
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Provider Business Mailing Address
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Address Line | 9955 NW 49TH PL
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City | CORAL SPRINGS
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State | FL
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Zip | 33076-2472
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Country | US
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Telephone | 941-281-4038
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MICHAELLE VALCOURT
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Credential |
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Telephone | 5-457-5707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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