# INVIGORATION HEALTH CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033856307
- **Authorized official:** STACY WIDEMAN PMHNP (CEO/OWNER)
- **Authorized official phone:** (678) 235-4853

## Contact information

- **Practice address:** 8450 NW 102ND AVE, DORAL, FL 33178-4750
- **Practice address phone:** (360) 643-6562
- **Mailing address:** 370 HOLDINGS DR, LAWRENCEVILLE, GA 30044-5581

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/17/2022
- **Last updated:** 11/22/2022