Organization
MIND BODY SOUL WONDERFULLY MADE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY DAVIS FNP, PMHNP (OWNER)
(757) 966-1270
Entity
Organization
Contact information
Practice address
355 CRAWFORD ST STE 102, PORTSMOUTH, VA 23704-2817
(757) 966-1270
(757) 966-2967
Mailing address
355 CRAWFORD ST STE 102, PORTSMOUTH, VA 23704-2817
(757) 966-1270
(757) 966-2967
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/20/2023
Last updated
09/20/2023
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