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General NPI Number Information
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NPI Number | 1902761596
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Entity Type | Organization
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Legal Business Name | DIVINUS HEALTH SOLUTIONS LLC
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 7171 NORTH 9TH AVE UNIT B-8
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City | PENSACOLA
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State | FL
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Zip | 32504
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Country | US
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Telephone | 310-486-1919
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Fax |
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Provider Business Mailing Address
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Address Line | 362 GULF BREEZE PKWY # 414
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City | GULF BREEZE
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State | FL
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Zip | 32561-4492
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MICHELE SUTHERLAND
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Credential |
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Telephone | 310-486-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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