MEDICARE: HILTON HOLISTIC HEALTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	3619	FL

General Provider Information

NPI Number	:	1093107518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILTON HOLISTIC HEALTH, INC.

Provider Business Mailing Address
First Line	:	405 2ND ST S
Second Line	:	STE A
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-4014
Country	:	US
Telephone Number	:	727-433-8314
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 2ND ST S
Second Line	:	STE A
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-4014
Country	:	US
Telephone Number	:	727-433-8314
Fax Number	:

Authorized Official
Title or Position	:	DOM, AP, CEO/CMO
Name	:	DE'NICEA HILTON
Credential	:	DOM, AP
Telephone Number	:	813-625-0178

Provider Enumeration Date	:	02/19/2015
Last Update Date	:	02/19/2015

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