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General NPI Number Information
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NPI Number | 1871497107
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Entity Type | Organization
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Legal Business Name | ENDEVAWELL LLC
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 155 FOUNTAINS WAY STE 6
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City | ST JOHNS
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State | FL
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Zip | 32259-1144
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Country | US
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Telephone | 904-342-5455
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Fax |
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Provider Business Mailing Address
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Address Line | 155 FOUNTAINS WAY STE 6
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City | ST JOHNS
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State | FL
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Zip | 32259-1144
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Country | US
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Telephone | 904-342-5455
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | ROBERT T. HARDMAN
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Credential | DC
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Telephone | 904-342-5455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #2
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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 | NULL
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State | NULL
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