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General NPI Number Information
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NPI Number | 1902668809
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Entity Type | Organization
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Legal Business Name | DEFINITIVE BEAUTY L.L.C.
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Dates
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Enumeration Date | 01/25/2024
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 3520 AVALON PARK EAST BLVD STE 301
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City | ORLANDO
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State | FL
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Zip | 32828-7367
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Country | US
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Telephone | 407-319-5378
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Fax |
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Provider Business Mailing Address
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Address Line | 3520 AVALON PARK EAST BLVD STE 301
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City | ORLANDO
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State | FL
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Zip | 32828-7367
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Country | US
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Telephone | 407-319-5378
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Fax |
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Authorized Official
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Title or Position | PRACTITIONER
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Name | MRS. KERLINE DORT BROWN
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Credential | AUTONOMOUS ARNP- WHN
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Telephone | 407-319-5378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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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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