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General NPI Number Information
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NPI Number | 1871108274
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Entity Type | Organization
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Legal Business Name | SOUTHERN MAGNOLIA HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 09/11/2020
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 533 N NOVA RD STE 209
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City | ORMOND BEACH
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State | FL
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Zip | 32174-4422
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Country | US
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Telephone | 407-590-0377
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Fax |
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Provider Business Mailing Address
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Address Line | 490 N YONGE ST
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5252
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Country | US
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Telephone | 407-590-0377
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Fax |
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Authorized Official
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Title or Position | OWNER/APRN
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Name | HOPE A KING
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Credential | APRN
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Telephone | 407-590-0377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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