Organization
BEAUTY & WELLNESS BOUTIQ
Active
Other names
Beauty & Wellness Med Spa
Organization subpart
No
Provider details
NPI number
Authorized official
LISA RICHARDS APRN (OWNER)
(813) 409-6931
Entity
Organization
Contact information
Practice address
14846 TAMIAMI TRL, NORTH PORT, FL 34287-2701
(813) 409-6931
Mailing address
4578 N BISCAYNE DR, NORTH PORT, FL 34291-7081
(813) 409-6931
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/13/2024
Last updated
09/13/2024
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