# ICONIC HEALTH LLC

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

## Provider details

- **NPI number:** 1700460383
- **Authorized official:** SARAH RAVELLI ARNP (CEO, LEAD PRACTITIONER)
- **Authorized official phone:** (330) 277-1131

## Contact information

- **Practice address:** 1898 W HILLSBORO BLVD STE H, DEERFIELD BEACH, FL 33442-1434
- **Practice address phone:** (954) 571-9392
- **Practice address fax:** (954) 289-4888
- **Mailing address:** 1898 W HILLSBORO BLVD STE H, DEERFIELD BEACH, FL 33442-1434
- **Mailing address phone:** (954) 571-9392
- **Mailing address fax:** (954) 289-4888

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/10/2021
- **Last updated:** 05/19/2021