Organization Active NPI

Peace Healing and Wellness LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Boca Raton, FL
National Provider Identifier
1619776374
Registry record updated Jun 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
PEACE HEALING AND WELLNESS LLC
Practice address
1650 S Dixie Hwy Ste 203
Boca Raton, FL 33432-7461
Phone
(954) 671-0258
NPI assigned
Mar 13, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2025

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

Authorized official

Name
Tracy Ann Damiela Thompson, APRN
Title
Co-Owner
Phone
(954) 671-0258

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

1650 S Dixie Hwy Ste 203
Boca Raton, FL 33432-7461

Mailing address

1650 S Dixie Hwy Ste 203
Boca Raton, FL 33432-7461
Phone (954) 671-0258

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250725001231 FL Part B Supplier - Clinic/Group Practice 2668989609 Receives reassigned benefits from 2 practitioners
Practice locations: Boca Raton, FL

National Provider Directory

National Provider Directory

Locations

4907 NE 12th Ave
Oakland Park, FL 33334

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1741824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750377600000",
    "number": "1619776374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 S DIXIE HWY STE 203",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334327461",
            "telephone_number": "954-671-0258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 S DIXIE HWY STE 203",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334327461",
            "telephone_number": "954-671-0258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACE HEALING AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-13",
        "last_updated": "2025-06-20",
        "certification_date": "2025-06-20",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "TRACY ANN",
        "authorized_official_middle_name": "DAMIELA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "954-671-0258",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.