Organization
AMETHYST WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY COOPERSMITH DNP/ARNP (OWNER)
(386) 503-7950
Entity
Organization
Contact information
Practice address
145 CYPRESS POINT PKWY, SUITE 208B, PALM COAST, FL 32164-8426
(386) 503-7950
Mailing address
51 RENWORTH LN, PALM COAST, FL 32164-6627
(386) 503-7950
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
9242220
FL
Other
Enumeration date
01/26/2016
Last updated
02/08/2016
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