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General NPI Number Information
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NPI Number | 1962903666
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Entity Type | Organization
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Legal Business Name | SERENITY DME LLC
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 04/29/2019
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Provider Practice Location Address
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Address Line | 111 N 2ND ST STE 101
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City | FORT PIERCE
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State | FL
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Zip | 34950
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Country | US
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Telephone | 772-466-4818
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Fax |
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Provider Business Mailing Address
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Address Line | 500 NE SPANISH RIVER BLVD STE 202
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City | BOCA RATON
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State | FL
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Zip | 33431-4568
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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 | OWNER
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Name | KRISTA LEE BROCK
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Credential |
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Telephone | 954-702-5783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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