Organization
TREASURE COAST KETAMINE WELLNESS & IV NUTRITION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY JARRELL MCCRACKEN CRNA (OWNER)
(352) 262-8439
Entity
Organization
Contact information
Practice address
777 37TH ST STE B106, VERO BEACH, FL 32960-7301
(772) 907-5917
(772) 907-5917
Mailing address
777 37TH ST STE B106, VERO BEACH, FL 32960-7301
(772) 907-5917
(772) 907-5917
Taxonomy
Speciality
Code
Description
License number
State
163WI0500X
Infusion Therapy Registered Nurse
—
—
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
08/18/2020
Last updated
04/28/2022
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