Provider Demographics
NPI:1720840168
Name:TRADITION HEALTH AND WELLNESS CLINIC PLLC
Entity Type:Organization
Organization Name:TRADITION HEALTH AND WELLNESS CLINIC PLLC
Other - Org Name:BLUE SKIES HEALTH & WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VIZZINI
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:772-934-4990
Mailing Address - Street 1:10198 SW VILLAGE PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2592
Mailing Address - Country:US
Mailing Address - Phone:772-934-4990
Mailing Address - Fax:772-934-4991
Practice Address - Street 1:10198 SW VILLAGE PKWY STE 105
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2592
Practice Address - Country:US
Practice Address - Phone:772-934-4990
Practice Address - Fax:772-934-4991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty