Provider Demographics
NPI:1275313918
Name:SERENITY WELLNESS AND FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:SERENITY WELLNESS AND FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:TUTT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:386-873-4560
Mailing Address - Street 1:890 N BOUNDARY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3173
Mailing Address - Country:US
Mailing Address - Phone:386-873-4560
Mailing Address - Fax:
Practice Address - Street 1:890 N BOUNDARY AVE STE 101
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3173
Practice Address - Country:US
Practice Address - Phone:386-873-4560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty