Provider Demographics
NPI:1083322994
Name:THE WELLNESS NPS
Entity Type:Organization
Organization Name:THE WELLNESS NPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AISSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAQUIR
Authorized Official - Suffix:
Authorized Official - Credentials:DNP-APRN
Authorized Official - Phone:305-766-0392
Mailing Address - Street 1:1142 BANYAN DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2135
Mailing Address - Country:US
Mailing Address - Phone:305-766-0392
Mailing Address - Fax:
Practice Address - Street 1:17900 NW 5TH ST STE 104
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2809
Practice Address - Country:US
Practice Address - Phone:305-766-0392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty