Provider Demographics
NPI:1023465861
Name:OPTIMAL HEALTH CLINIC
Entity type:Organization
Organization Name:OPTIMAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISELOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDEA-AMOAKO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:817-813-8055
Mailing Address - Street 1:2140 HIGHWAY 157 N
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4847
Mailing Address - Country:US
Mailing Address - Phone:817-813-8055
Mailing Address - Fax:817-730-9068
Practice Address - Street 1:2140 HIGHWAY 157 N
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4847
Practice Address - Country:US
Practice Address - Phone:817-813-8055
Practice Address - Fax:817-730-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty