Organization
ALIVE & BLOSSOM HEALTHCARE LLC
Active
Other names
B12 Health Mobile
Organization subpart
No
Provider details
NPI number
Authorized official
MARGALY VALCOURT ARNP (MANAGER)
(954) 394-4793
Entity
Organization
Contact information
Practice address
190 CHAMPIONS VUE LOOP UNIT 408, DAVENPORT, FL 33897-4857
(954) 394-4793
Mailing address
190 CHAMPIONS VUE LOOP UNIT 408, DAVENPORT, FL 33897-4857
(954) 394-4793
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000
N/A
FL
Enumeration date
03/05/2021
Last updated
03/05/2021
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