Avanti Wellness Center Flllp

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

77644 Issued in FL

Legal business name

AVANTI WELLNESS CENTER FLLLP

Practice address

3574 US 1 S
Suite 113
St Augustine, FL 32086-6466

Phone

(904) 797-3115

Fax

(904) 797-2915

NPI assigned

May 14, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Randi B Brazer, LCSW

Title

Director of Operations

Phone

(904) 797-3115

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Avanti Wellness Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Avanti Wellness Center Flllp

  • Clinic/Center
  • St Augustine, FL
  • NPI 1528200029
  NPD tax ID

Locations

Practitioners 1

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

• Randi Bloom-Brazer, LCSW

  • Clinical Social Worker
  • St Augustine, FL
  • NPI 1740466929
  NPD (past)

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

{
    "created_epoch": "1273795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298851200000",
    "number": "1093033003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3574 US 1 S",
            "address_2": "SUITE 113",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320866466",
            "telephone_number": "904-797-3115",
            "fax_number": "904-797-2915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3574 US 1 S",
            "address_2": "SUITE 113",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320866466",
            "telephone_number": "904-797-3115",
            "fax_number": "904-797-2915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVANTI WELLNESS CENTER FLLLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-14",
        "last_updated": "2011-02-28",
        "status": "A",
        "authorized_official_last_name": "BRAZER",
        "authorized_official_first_name": "RANDI",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "904-797-3115",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "77644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Clinical Medical Laboratory in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.