Provider Demographics
NPI:1679359079
Name:INNOVATIVE WELLNESS, INC.
Entity Type:Organization
Organization Name:INNOVATIVE WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:239-390-1800
Mailing Address - Street 1:29250 US HIGHWAY 19 N LOT 40
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2169
Mailing Address - Country:US
Mailing Address - Phone:239-390-1800
Mailing Address - Fax:
Practice Address - Street 1:2206 CURLEW RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-6823
Practice Address - Country:US
Practice Address - Phone:239-390-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty