Provider Demographics
NPI:1891240693
Name:NUESSENCE LLC
Entity Type:Organization
Organization Name:NUESSENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAVINA
Authorized Official - Middle Name:V
Authorized Official - Last Name:VENKOVA-GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:813-966-9986
Mailing Address - Street 1:18001 MALAKAI ISLE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2991
Mailing Address - Country:US
Mailing Address - Phone:813-966-9986
Mailing Address - Fax:
Practice Address - Street 1:18001 MALAKAI ISLE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2991
Practice Address - Country:US
Practice Address - Phone:813-966-9986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9364586261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service