Provider Demographics
NPI:1831477553
Name:TREASURE COAST MEDICAL AND HOLISTIC CARE, LLC
Entity Type:Organization
Organization Name:TREASURE COAST MEDICAL AND HOLISTIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHELMETY-HENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:772-418-4036
Mailing Address - Street 1:1255 SW CURRY STREET
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2509
Mailing Address - Country:US
Mailing Address - Phone:772-418-4036
Mailing Address - Fax:
Practice Address - Street 1:1255 SW CURRY STREET
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-2509
Practice Address - Country:US
Practice Address - Phone:772-418-4036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363L00000X261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306428000Medicaid