# ALIVE & BLOSSOM HEALTHCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** B12 Health Mobile
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669067146
- **Authorized official:** MARGALY VALCOURT ARNP (MANAGER)
- **Authorized official phone:** (954) 394-4793

## Contact information

- **Practice address:** 190 CHAMPIONS VUE LOOP UNIT 408, DAVENPORT, FL 33897-4857
- **Practice address phone:** (954) 394-4793
- **Mailing address:** 190 CHAMPIONS VUE LOOP UNIT 408, DAVENPORT, FL 33897-4857
- **Mailing address phone:** (954) 394-4793

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/05/2021
- **Last updated:** 03/05/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0000000 | N/A | FL |