Provider Demographics
NPI:1558137364
Name:PAULUS, JAMES THOMAS (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:PAULUS
Suffix:
Gender:M
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15841 PORTOFINO SPGS BLVD
Mailing Address - Street 2:#107
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908
Mailing Address - Country:US
Mailing Address - Phone:239-872-7216
Mailing Address - Fax:
Practice Address - Street 1:15841 PORTOFINO SPGS BLVD
Practice Address - Street 2:#107
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-872-7216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3077754171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach