Provider Demographics
NPI:1275173155
Name:OPTIMAL HEALING HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:OPTIMAL HEALING HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSLAIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONATHAS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:786-285-2281
Mailing Address - Street 1:10143 CHESAPEAKE BAY DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-9184
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:239-443-4516
Practice Address - Street 1:10143 CHESAPEAKE BAY DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-9184
Practice Address - Country:US
Practice Address - Phone:786-285-2281
Practice Address - Fax:239-443-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty