Organization
SUCCESS WITH NO LIMITS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NIATIKQUA TIONSHAY GREEN (OWNER)
(352) 401-7662
Entity
Organization
Contact information
Practice address
948 N W 58TH COURT, OCALA, FL 34482
(352) 401-7662
(352) 622-6315
Mailing address
948 NW 58TH CT, OCALA, FL 34482-5186
(352) 401-7662
(352) 622-6315
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
000453000
FL
Other
Enumeration date
10/01/2010
Last updated
10/01/2010
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