Provider Demographics
NPI:1063819548
Name:FULL-OUT WELLNESS HEALTHCARE STAFFING
Entity type:Organization
Organization Name:FULL-OUT WELLNESS HEALTHCARE STAFFING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TASHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-307-9493
Mailing Address - Street 1:9263 THUNDERBOLT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-8054
Mailing Address - Country:US
Mailing Address - Phone:904-307-9493
Mailing Address - Fax:
Practice Address - Street 1:9263 THUNDERBOLT DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-8054
Practice Address - Country:US
Practice Address - Phone:904-307-9493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1757164W00000X, 163W00000X, 374700000X, 376K00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No374700000XNursing Service Related ProvidersTechnicianGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty