Organization
XTREME NATURAL BODY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. YVONNE MARIE GOOD APRN (APRN / OWNER)
(443) 846-9100
Entity
Organization
Contact information
Practice address
534 PARK AVE STE 6, ORANGE PARK, FL 32073-3109
(443) 846-9100
Mailing address
534 PARK AVE STE 6, ORANGE PARK, FL 32073-3109
(904) 999-1363
(904) 966-4006
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316240716
—
FL
01
—
9432176
LICENSE NUMBER
FL
Enumeration date
10/24/2022
Last updated
03/21/2023
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