Organization
ILLUSIONS WELLNESS AND RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NYDIA M WHITAKER ARNP (OWNER)
(723) 577-6323
Entity
Organization
Contact information
Practice address
800 VIGINIA AVE, STE 59 B, FORT PIERCE, FL 34982
(772) 577-6323
Mailing address
800 VIGINIA AVE, STE 59 B, FORT PIERCE, FL 34982
(772) 577-6323
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
08/13/2024
Last updated
08/26/2024
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