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General NPI Number Information
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NPI Number | 1851729693
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Entity Type | Organization
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Legal Business Name | INNER BALANCE FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 10/14/2013
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 1801 SE HILLMOOR DRIVE SUITE C-106
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City | PORT ST. LUCIE
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State | FL
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Zip | 34952-7551
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Country | US
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Telephone | 772-249-0636
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Fax | 772-237-3114
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Provider Business Mailing Address
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Address Line | 1801 SE HILLMOOR DRIVE SUITE C-106
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City | PORT ST. LUCIE
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State | FL
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Zip | 34952-7551
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Country | US
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Telephone | 772-249-0636
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Fax | 772-237-3114
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Authorized Official
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Title or Position | OWNER
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Name | DR. DIONNE LAYNE HINDS
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Credential | DO
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Telephone | 772-249-0636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME106391
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License Number State | FL
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