Complete Ketamine Solutions Hollywood LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

COMPLETE KETAMINE SOLUTIONS HOLLYWOOD LLC

Practice address

2450 Hollywood Blvd Ste 701
Hollywood, FL 33020-6628

Phone

(954) 367-5316

Fax

(954) 367-5374

NPI assigned

Oct 20, 2021

Last updated

Oct 20, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Clint Fletcher, CRNA

Title

Owner

Phone

(615) 300-3096

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tresa Bietola, FNP

  • Nurse Practitioner
  • Hollywood, FL
  • NPI 1093477895
  NPD
• Stephanie Monique Corbo, FNP-C

  • Family Nurse Practitioner
  • Sunrise, FL
  • NPI 1265116461
  NPD (past)

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

{
    "created_epoch": "1634688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634688000000",
    "number": "1295498830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 HOLLYWOOD BLVD STE 701",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330206628",
            "telephone_number": "954-367-5316",
            "fax_number": "954-367-5374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 HOLLYWOOD BLVD STE 701",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330206628",
            "telephone_number": "954-367-5316",
            "fax_number": "954-367-5374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE KETAMINE SOLUTIONS HOLLYWOOD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-20",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "CLINT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-300-3096",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Multi-Specialty Clinic/Center in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Multi-Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; 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.