Provider Demographics
NPI:1740014505
Name:PURE HOPE WEIGHT LOSS AND HEALTHCARE, LLC
Entity type:Organization
Organization Name:PURE HOPE WEIGHT LOSS AND HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:AUTONOMOUS APRN, FNP
Authorized Official - Phone:904-815-8353
Mailing Address - Street 1:155 BARTRAM MARKET DR STE 135-185
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4581
Mailing Address - Country:US
Mailing Address - Phone:904-815-8353
Mailing Address - Fax:904-295-3947
Practice Address - Street 1:145 HILDEN RD STE 123
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-8403
Practice Address - Country:US
Practice Address - Phone:904-815-8353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care