# HYDRATION EXPERIENCE

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

## Provider details

- **NPI number:** 1679167894
- **Authorized official:** LOCIANNA BLACKWELL APRN (NURSE PRACTITIONER)
- **Authorized official phone:** (954) 765-9521

## Contact information

- **Practice address:** 1329 NW 10TH ST, DANIA BEACH, FL 33004-2341
- **Practice address phone:** (954) 765-9521
- **Mailing address:** 1329 NW 10TH ST, DANIA BEACH, FL 33004-2341
- **Mailing address phone:** (954) 765-9521

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/28/2021
- **Last updated:** 02/28/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1356657704 | — | GA |