Organization
P.B. & R'S ENTERPRISES LLC
Active
Other names
Prana Blu Medspa
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BETHZALI DEL C. PHILLIPS M.E. (MANAGING MEMEBER)
(727) 330-7733
Entity
Organization
Contact information
Practice address
1200 S HIGHLAND AVE, SUITE 'B', CLEARWATER, FL 33756-4334
(727) 330-7733
(727) 447-6008
Mailing address
1200 S HIGHLAND AVE, SUITE 'B', CLEARWATER, FL 33756-4334
(727) 330-7733
(727) 447-6008
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
ME86204
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851697056
PROVIDER NPI
FL
05
—
278958500
—
FL
01
—
P00945853
PROVIDER PTAN
FL
Enumeration date
12/16/2011
Last updated
12/16/2011
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