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General NPI Number Information
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NPI Number | 1891245262
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Entity Type | Organization
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Legal Business Name | JADE WELLNESS
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 2717 E OAKLAND PARK BLVD STE 201
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City | FORT LAUDERDALE
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State | FL
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Zip | 33306-1663
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Country | US
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Telephone | 305-332-4244
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Fax |
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Provider Business Mailing Address
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Address Line | 2717 E OAKLAND PARK BLVD STE 201
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City | FORT LAUDERDALE
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State | FL
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Zip | 33306-1663
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Country | US
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Telephone | 305-332-4244
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST/OWNER
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Name | ELIZIANE LARSEN NASCIMENTO
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Credential | LAC
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Telephone | 305-332-4244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP3013
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License Number State | FL
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