Organization
INVIGORATION HEALTH CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY WIDEMAN PMHNP (CEO/OWNER)
(678) 235-4853
Entity
Organization
Contact information
Practice address
8450 NW 102ND AVE, DORAL, FL 33178-4750
(360) 643-6562
Mailing address
370 HOLDINGS DR, LAWRENCEVILLE, GA 30044-5581
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/17/2022
Last updated
11/22/2022
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