Innovative Healthy Aging, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

INNOVATIVE HEALTHY AGING, LLC

Practice address

1120 Pinellas Bayway S Ste 105
Tierra Verde, FL 33715-1500

Phone

(727) 282-9724

Fax

(727) 317-0043

NPI assigned

Jun 22, 2023

Last updated

Mar 20, 2024By 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

Teresa Annette Nesbit, CNM, APRN

Title

Nurse Practioner

Phone

(727) 282-9724

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1687392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710892800000",
    "number": "1669158929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 2ND AVE S",
            "city": "TIERRA VERDE",
            "state": "FL",
            "postal_code": "337152249",
            "telephone_number": "407-421-6600",
            "fax_number": "727-317-0043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 PINELLAS BAYWAY S STE 105",
            "city": "TIERRA VERDE",
            "state": "FL",
            "postal_code": "337151500",
            "telephone_number": "727-282-9724",
            "fax_number": "727-317-0043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE HEALTHY AGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-22",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "NESBIT",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "ANNETTE",
        "authorized_official_title_or_position": "NURSE PRACTIONER",
        "authorized_official_telephone_number": "727-282-9724",
        "authorized_official_credential": "CNM, APRN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erika Christine Furones
• Carol Gensch
• Gyenyame Medical Services
• Lisa Heller Chase, PT
• Julie Lynn Hiatt
• Charleen L. Ise, MD
• Kori Kogan, PTA
• Vincent Patrick Kunz, MD
• Jan Marie Lundberg, D.C.
• Betty Menegia Chaviano

• Clinic/Center in Tierra Verde, FL
• Providers in Tierra Verde, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; 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.