Organization
BEAUTIFULLY GRACED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE DENISE JERNIGHAN (FOUNDER)
(321) 220-0862
Entity
Organization
Contact information
Practice address
2155 PALM BAY RD NE STE 7, PALM BAY, FL 32905-2907
(321) 220-0862
Mailing address
2155 PALM BAY RD NE STE 7, PALM BAY, FL 32905-2907
(321) 220-0862
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CL1284556
COSMETOLOGY LICENSE
FL
Enumeration date
08/30/2022
Last updated
01/11/2024
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