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Organization

RESTORING WELLNESS PRIMARY CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JAIMIE LOUSIE MICKEY MD (OWNER PHYSICIAN)
(813) 362-5748
Entity
Organization

Contact information

Practice address
10597 US HIGHWAY 19 N, PINELLAS PARK, FL 33782-3413
(727) 351-1700
(727) 351-1701
Mailing address
5044 DOVER ST NE, ST PETERSBURG, FL 33703-3215
(813) 362-5748
(737) 351-1701

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
ME103083
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000994100
FL
Enumeration date
08/07/2017
Last updated
10/11/2020
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