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General NPI Number Information
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NPI Number | 1932925120
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Entity Type | Organization
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Legal Business Name | ST. PETERSBURG CENTER FOR PERFORMANCE AND WEIGHT LOSS
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 3948 CENTRAL AVE STE 2
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City | ST PETERSBURG
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State | FL
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Zip | 33711-1238
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Country | US
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Telephone | 386-801-3448
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Fax |
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Provider Business Mailing Address
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Address Line | 3948 CENTRAL AVE STE 2
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City | ST PETERSBURG
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State | FL
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Zip | 33711-1238
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Country | US
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Telephone | 386-801-3448
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Fax |
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Authorized Official
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Title or Position | AMBR
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Name | CHERITH RICKELS
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Credential | APRN
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Telephone | 386-801-3448
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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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