| Intentionally Well, Llc | |
|
2100 Se Hillmoor Dr Ste 101 Port St Lucie FL 34952-8057 | |
| (772) 877-2311 | |
| (772) 249-0638 |
| Full Name | Intentionally Well, Llc |
|---|---|
| Speciality | Nurse Practitioner - Family |
| Location | 2100 Se Hillmoor Dr Ste 101, Port St Lucie, Florida |
| Authorized Official Name and Position | Theresa Anne Pinder (SOLE MEMBER, CEO) |
| Authorized Official Contact | 7722159946 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Intentionally Well, Llc 2100 Se Hillmoor Dr Ste 101 Port St Lucie FL 34952-8057 Ph: (772) 877-2311 | Intentionally Well, Llc 2100 Se Hillmoor Dr Ste 101 Port St Lucie FL 34952-8057 Ph: (772) 877-2311 |
| NPI Number | 1922426402 |
|---|---|
| Provider Enumeration Date | 04/02/2014 |
| Last Update Date | 07/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922426402 | NPI | - | NPPES |
| 1912256538 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME69414 (Florida) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 1476272 (Florida) | Primary |
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