Provider Demographics
NPI:1346006392
Name:JB DIVINE WELLNESS LLC
Entity Type:Organization
Organization Name:JB DIVINE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEATTIE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:561-677-0017
Mailing Address - Street 1:9221 SUN TERRACE CIRCLE #D
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33403
Mailing Address - Country:US
Mailing Address - Phone:561-677-0017
Mailing Address - Fax:
Practice Address - Street 1:9221 SUN TERRACE CIRCLE #D
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403
Practice Address - Country:US
Practice Address - Phone:561-677-0017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty