MEDICARE: DIVINE WELLNESS PARTNERS, LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1881572238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE WELLNESS PARTNERS, LLC

Provider Business Mailing Address
First Line	:	4680 LIPSCOMB ST NE STE 10B
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-2928
Country	:	US
Telephone Number	:	321-364-3758
Fax Number	:	833-635-8722

Provider Business Practice Location Address
First Line	:	4680 LIPSCOMB ST NE STE 10B
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-2928
Country	:	US
Telephone Number	:	321-364-3758
Fax Number	:	833-635-8722

Authorized Official
Title or Position	:	OWNER/FOUNDER
Name	:	MRS. TIFFANY JAMES
Credential	:	APRN, FNP-C, BCPA
Telephone Number	:	321-364-3758

Provider Enumeration Date	:	08/25/2025
Last Update Date	:	02/12/2026

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Directions to “DIVINE WELLNESS PARTNERS, LLC ” Practice Location

Language	Start Address	Practice Location

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