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Organization
THE HAIR DIVE LLC
Active
Organization
THE HAIR DIVE LLC
Active
Other names
Queen Creations LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SIMONE DANIELLE DURANT HAIR LOSS SPECIALIST (PRESIDENT)
(727) 265-0013
Entity
Organization
Contact information
Practice address
6920 22ND AVE N STE 120, SAINT PETERSBURG, FL 33710-3920
(727) 265-0013
Mailing address
2822 54TH AVE S # 213, ST PETERSBURG, FL 33712-4610
(727) 265-0013
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NULL
332BC3200X
Customized Equipment (DME)
—
NULL
335E00000X
Prosthetic/Orthotic Supplier
—
NULL
Other
Enumeration date
06/17/2022
Last updated
03/02/2023
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