# THE HAIR DIVE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Queen Creations LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548991888
- **Authorized official:** MS. SIMONE DANIELLE DURANT HAIR LOSS SPECIALIST (PRESIDENT)
- **Authorized official phone:** (727) 265-0013

## Contact information

- **Practice address:** 6920 22ND AVE N STE 120, SAINT PETERSBURG, FL 33710-3920
- **Practice address phone:** (727) 265-0013
- **Mailing address:** 2822 54TH AVE S \# 213, ST PETERSBURG, FL 33712-4610
- **Mailing address phone:** (727) 265-0013

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | — |

## Other

- **Enumeration date:** 06/17/2022
- **Last updated:** 03/02/2023