Provider Demographics
NPI:1629943311
Name:MOXIE WELLNESS CENTER LLC
Entity type:Organization
Organization Name:MOXIE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YULEISY
Authorized Official - Middle Name:
Authorized Official - Last Name:COTO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:786-975-6993
Mailing Address - Street 1:12515 ORANGE DR STE 803
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4309
Mailing Address - Country:US
Mailing Address - Phone:786-975-6993
Mailing Address - Fax:954-405-8541
Practice Address - Street 1:12515 ORANGE DR STE 803
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4309
Practice Address - Country:US
Practice Address - Phone:786-975-6993
Practice Address - Fax:954-405-8541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-10
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty