Provider Demographics
NPI:1265944714
Name:WINTER HAVEN ACUPUNCTURE LLC
Entity type:Organization
Organization Name:WINTER HAVEN ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAZET
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, LAC
Authorized Official - Phone:863-662-3756
Mailing Address - Street 1:539 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3054
Mailing Address - Country:US
Mailing Address - Phone:863-662-3756
Mailing Address - Fax:863-662-3984
Practice Address - Street 1:539 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3054
Practice Address - Country:US
Practice Address - Phone:863-662-3756
Practice Address - Fax:863-662-3984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1254171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty