# WELLSPRING PRESERVATION MEDICAL VACATION BOUTIQUE & SPA, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1306301635
- **Authorized official:** MS. SOPHIA M FERGUSON APRN (AGACNP-BC)
- **Authorized official phone:** (786) 261-9088

## Contact information

- **Practice address:** 14051 SW 152ND TER, MIAMI, FL 33177-0910
- **Practice address phone:** (786) 261-9088
- **Mailing address:** 14051 SW 152ND TER, MIAMI, FL 33177-0910
- **Mailing address phone:** (786) 261-9088

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 01/31/2019
- **Last updated:** 01/31/2019