Heaven Wellness Medical Center, Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

HEAVEN WELLNESS MEDICAL CENTER, INC.

Practice address

11961 N Florida Ave Ste B
Tampa, FL 33612-5213

Phone

(813) 415-2891

Fax

(813) 443-3149

NPI assigned

Sep 22, 2022

Organization subpart

No

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

Authorized official

Name

Ms. Lazara Hurtado HernandezNPI 1275004301

Title

Owner

Phone

(813) 409-9457

Specialties & licenses 4

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lazara Hurtado Hernandez

  • Behavior Technician
  • Tampa, FL
  • NPI 1275004301
  NPD Authorized official

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

{
    "created_epoch": "1663804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1053034298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15542",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336845542",
            "telephone_number": "813-415-2891",
            "fax_number": "813-443-3149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11961 N FLORIDA AVE STE B",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336125213",
            "telephone_number": "813-415-2891",
            "fax_number": "813-443-3149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAVEN WELLNESS MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-22",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A",
        "authorized_official_last_name": "HURTADO HERNANDEZ",
        "authorized_official_first_name": "LAZARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-409-9457",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Genevieve Rae Heath, D.C.
• Jonathon Edward Heath, M.D.
• Sarah Heath, PHD
• Sue Ellen Heath, C.R.N.A.
• Heaven to Earth Care
• Brooke Marie Hebauf, D.C.
• Jadie Lindsey Heberlein, ARNP-C
• Caleb Hebert, DC
• Damien Paul Hebert, CRNA
• Danielle N Hebert, APRN-C

• Clinic/Center in Tampa, FL
• Providers in Tampa, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 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.