Basic Information
| Provider Information | |||||||||
| NPI: | 1417675687 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPTIMUM HEALTH & WELLNESS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3702 W SPRUCE ST # 1350 | ||||||||
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| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336072553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8638388754 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11048 SUNDRIFT DR | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8638388754 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2022 | ||||||||
| LastUpdateDate: | 08/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | HUGHES | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8638388754 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | APRN | ||||||||
| NPICertificationDate: | 08/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.