Provider Demographics
NPI:1659090694
Name:TOP MEDSPA & CLINIC
Entity Type:Organization
Organization Name:TOP MEDSPA & CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEACH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:407-878-3208
Mailing Address - Street 1:2768 W LAKE MARY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3524
Mailing Address - Country:US
Mailing Address - Phone:407-878-3208
Mailing Address - Fax:321-234-0229
Practice Address - Street 1:2768 W LAKE MARY BLVD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3524
Practice Address - Country:US
Practice Address - Phone:321-230-6043
Practice Address - Fax:321-234-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care