Provider Demographics
NPI:1790467124
Name:BODYWERKS LLC
Entity Type:Organization
Organization Name:BODYWERKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:904-600-4405
Mailing Address - Street 1:1626 NORTHGLEN CIR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-6580
Mailing Address - Country:US
Mailing Address - Phone:904-600-4405
Mailing Address - Fax:
Practice Address - Street 1:1409 KINGSLEY AVE STE 8
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4553
Practice Address - Country:US
Practice Address - Phone:904-600-4405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty