Provider Demographics
NPI:1679603211
Name:SERENITY WELL BEING CLINIC PA
Entity Type:Organization
Organization Name:SERENITY WELL BEING CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZANIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBOUBI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-631-1592
Mailing Address - Street 1:36181 E LAKE RD
Mailing Address - Street 2:SUITE 55
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3142
Mailing Address - Country:US
Mailing Address - Phone:727-631-1592
Mailing Address - Fax:
Practice Address - Street 1:1840 MEASE DR
Practice Address - Street 2:SUITE 315
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6602
Practice Address - Country:US
Practice Address - Phone:727-631-1592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3060213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6185550001Medicare NSC