Organization
AVANTI WELLNESS CENTER FLLLP
Active
Other names
Avanti Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RANDI B BRAZER LCSW (DIRECTOR OF OPERATIONS)
(904) 797-3115
Entity
Organization
Contact information
Practice address
3574 US 1 S, SUITE 113, ST AUGUSTINE, FL 32086-6466
(904) 797-3115
(904) 797-2915
Mailing address
3574 US 1 S, SUITE 113, ST AUGUSTINE, FL 32086-6466
(904) 797-3115
(904) 797-2915
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
261Q00000X
Clinic/Center
Primary
HCC7499
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001136302
—
FL
Enumeration date
03/30/2009
Last updated
08/18/2011
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