Provider Demographics
NPI:1760096135
Name:CONCIERGENP WELLNESS CENTER
Entity Type:Organization
Organization Name:CONCIERGENP WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:954-684-5493
Mailing Address - Street 1:1001 N FEDERAL HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2416
Mailing Address - Country:US
Mailing Address - Phone:754-444-9173
Mailing Address - Fax:786-221-3179
Practice Address - Street 1:1001 N FEDERAL HWY STE 200
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2416
Practice Address - Country:US
Practice Address - Phone:754-444-9173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty