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General NPI Number Information
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NPI Number | 1851169510
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Entity Type | Organization
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Legal Business Name | EQUILIBRIUM WELLNESS CARE, LLC
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 850 S 21ST ST STE B
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City | FORT PIERCE
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State | FL
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Zip | 34950-4829
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Country | US
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Telephone | 772-448-4456
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Fax | 772-448-4674
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Provider Business Mailing Address
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Address Line | 850 S 21ST ST STE B
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City | FORT PIERCE
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State | FL
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Zip | 34950-4829
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Country | US
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Telephone | 772-448-4456
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Fax | 772-448-4674
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Authorized Official
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Title or Position | OWNER
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Name | LESLY ESTRIPLET
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Credential | APRN
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Telephone | 772-448-4456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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