# AMETHYST WELLNESS LLC

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

## Provider details

- **NPI number:** 1376900019
- **Authorized official:** AMY COOPERSMITH DNP/ARNP (OWNER)
- **Authorized official phone:** (386) 503-7950

## Contact information

- **Practice address:** 145 CYPRESS POINT PKWY, SUITE 208B, PALM COAST, FL 32164-8426
- **Practice address phone:** (386) 503-7950
- **Mailing address:** 51 RENWORTH LN, PALM COAST, FL 32164-6627
- **Mailing address phone:** (386) 503-7950

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | 9242220 | FL | Yes |

## Other

- **Enumeration date:** 01/26/2016
- **Last updated:** 02/08/2016