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Organization
INTENTIONALLY WELL, LLC
Active
Organization
INTENTIONALLY WELL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA ANNE PINDER APN (SOLE MEMBER, CEO)
(772) 215-9946
Entity
Organization
Contact information
Practice address
2100 SE HILLMOOR DR STE 101, PORT ST LUCIE, FL 34952-8057
(772) 877-2311
(772) 249-0638
Mailing address
2100 SE HILLMOOR DR STE 101, PORT ST LUCIE, FL 34952-8057
(772) 877-2311
(772) 249-0638
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
ME69414
FL
363LF0000X
Family Nurse Practitioner
Primary
1476272
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912256538
NPI
—
Enumeration date
04/02/2014
Last updated
07/19/2024
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