Provider Demographics
NPI:1740163757
Name:PURE PATH HEALING LLC
Entity type:Organization
Organization Name:PURE PATH HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ALEA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SOHN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:941-301-6311
Mailing Address - Street 1:220 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2161
Mailing Address - Country:US
Mailing Address - Phone:941-301-6311
Mailing Address - Fax:
Practice Address - Street 1:7901 4TH ST N # 28537
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4305
Practice Address - Country:US
Practice Address - Phone:941-301-6311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty