Provider Demographics
NPI:1396402624
Name:HOLISTIC VIRTUAL-JANTIF HEALTHCARE
Entity Type:Organization
Organization Name:HOLISTIC VIRTUAL-JANTIF HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IYOHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORENCE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:713-374-5121
Mailing Address - Street 1:10907 VANDERFORD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-4764
Mailing Address - Country:US
Mailing Address - Phone:713-374-5121
Mailing Address - Fax:
Practice Address - Street 1:10907 VANDERFORD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-4764
Practice Address - Country:US
Practice Address - Phone:713-374-5121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14044324Medicaid