Provider Demographics
NPI:1982336327
Name:OCEANSIDE HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:OCEANSIDE HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MACE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:304-415-5783
Mailing Address - Street 1:8116 AMALFI CIR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34951-4400
Mailing Address - Country:US
Mailing Address - Phone:304-415-5783
Mailing Address - Fax:
Practice Address - Street 1:8116 AMALFI CIR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34951-4400
Practice Address - Country:US
Practice Address - Phone:304-415-5783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty