Provider Demographics
NPI:1003639238
Name:NUGENICS WELLNESS CORPORATION
Entity type:Organization
Organization Name:NUGENICS WELLNESS CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:757-770-7078
Mailing Address - Street 1:100 7TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-4800
Mailing Address - Country:US
Mailing Address - Phone:207-305-3761
Mailing Address - Fax:207-305-3761
Practice Address - Street 1:100 7TH ST STE 104
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-4800
Practice Address - Country:US
Practice Address - Phone:207-305-3761
Practice Address - Fax:207-305-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty