Organization
WELLSPRING PRESERVATION MEDICAL VACATION BOUTIQUE & SPA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SOPHIA M FERGUSON APRN (AGACNP-BC)
(786) 261-9088
Entity
Organization
Contact information
Practice address
14051 SW 152ND TER, MIAMI, FL 33177-0910
(786) 261-9088
Mailing address
14051 SW 152ND TER, MIAMI, FL 33177-0910
(786) 261-9088
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/31/2019
Last updated
01/31/2019
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