Organization
SUN MIRACLE WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANTA K DAVIS AGNP-C (OWNER)
(727) 741-8475
Entity
Organization
Contact information
Practice address
13575 58TH ST N STE 200, CLEARWATER, FL 33760-3739
(727) 741-8475
Mailing address
6740 CROSSWINDS DR N STE C, ST PETERSBURG, FL 33710-5472
(727) 954-0010
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/14/2022
Last updated
09/25/2023
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