Provider Demographics
NPI:1659932655
Name:INNER BALANCE FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:INNER BALANCE FAMILY MEDICINE, LLC
Other - Org Name:INNER BALANCE FAMILY MEDICINE, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:HINDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-249-0636
Mailing Address - Street 1:1400 SE GOLDTREE DRIVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7583
Mailing Address - Country:US
Mailing Address - Phone:772-323-0040
Mailing Address - Fax:772-237-5849
Practice Address - Street 1:1400 SE GOLDTREE DRIVE
Practice Address - Street 2:SUITE 207
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7583
Practice Address - Country:US
Practice Address - Phone:772-323-0040
Practice Address - Fax:772-237-5849
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNER BALANCE FAMILY MEDICINE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-21
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty