Invigoration Health Corp

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

INVIGORATION HEALTH CORP

Practice address

8450 NW 102ND Ave
Doral, FL 33178-4750

Phone

(360) 643-6562

NPI assigned

May 17, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stacy Wideman, PMHNP

Title

Ceo/Owner

Phone

(678) 235-4853

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669075200000",
    "number": "1033856307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 HOLDINGS DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300445581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8450 NW 102ND AVE",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331784750",
            "telephone_number": "360-643-6562"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3235 Satellite Blvd Ste 300",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "GA",
            "postal_code": "300968688",
            "country_code": "US",
            "telephone_number": "360-643-6562",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INVIGORATION HEALTH CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-17",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-22",
        "status": "A",
        "authorized_official_last_name": "WIDEMAN",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "678-235-4853",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Doral, FL
• Providers in Doral, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.