| Nu Vitality Hydration And Wellness | |
|
2719 Hollywood Blvd # L-12 Hollywood FL 33020-4821 | |
| (954) 852-6954 | |
| Not Available |
| Full Name | Nu Vitality Hydration And Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 2719 Hollywood Blvd # L-12, Hollywood, Florida |
| Authorized Official Name and Position | Dorrian Chisholm (FNP-C) |
| Authorized Official Contact | 9549981131 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nu Vitality Hydration And Wellness 2719 Hollywood Blvd # L-12 Hollywood FL 33020-4821 Ph: (954) 852-6954 | Nu Vitality Hydration And Wellness 2719 Hollywood Blvd # L-12 Hollywood FL 33020-4821 Ph: (954) 852-6954 |
| NPI Number | 1164148011 |
|---|---|
| Provider Enumeration Date | 10/12/2022 |
| Last Update Date | 03/22/2023 |
| Medicare PECOS PAC ID | 3678942638 |
|---|---|
| Medicare Enrollment ID | O20221214000113 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164148011 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Dorrian S Chisholm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801394507 PECOS PAC ID: 5496092538 Enrollment ID: I20190128000614 |
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