Provider Demographics
NPI:1538048012
Name:INNOVATED HEALTH LLC
Entity type:Organization
Organization Name:INNOVATED HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEA
Authorized Official - Middle Name:JENIECE
Authorized Official - Last Name:WOOLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DNP-BC AND PMHNP
Authorized Official - Phone:757-214-4469
Mailing Address - Street 1:2035 RIDGE END RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-1028
Mailing Address - Country:US
Mailing Address - Phone:757-214-4469
Mailing Address - Fax:
Practice Address - Street 1:2035 RIDGE END RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-1028
Practice Address - Country:US
Practice Address - Phone:757-214-4469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-29
Last Update Date:2025-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty