Organization Active NPI

Aquarius Medical & Wellness Clinic, LLC

  • Primary Care Nurse Practitioner
  • Santa Fe, NM
National Provider Identifier
1689472904
Registry record updated Jul 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
AQUARIUS MEDICAL & WELLNESS CLINIC, LLC
Practice address
6 Calle Medico Ste 4
Santa Fe, NM 87505-4761
Phone
(813) 484-2335
Fax
(505) 395-9251
NPI assigned
Mar 4, 2025
Last updated
Jul 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2025

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

Authorized official

Name
Ms. Elizabeth Olis, CNPNPI 1346892866
Title
Owner
Phone
(813) 484-2335

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Primary Care Nurse Practitioner 363LP2300X Primary

Addresses

Primary practice location

6 Calle Medico Ste 4
Santa Fe, NM 87505-4761

Mailing address

6 Calle Medico Ste 4
Santa Fe, NM 87505-4761
Phone (813) 484-2335

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250710000342 NM Part B Supplier - Clinic/Group Practice 5496269599 Receives reassigned benefits from 1 practitioner
Practice locations: Santa Fe, NM

National Provider Directory

National Provider Directory

Locations

6 Calle Medico
Ste 4
Santa Fe, NM 87505
Phone (505) 498-0980

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1741046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753056000000",
    "number": "1689472904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 CALLE MEDICO STE 4",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875054761",
            "telephone_number": "813-484-2335",
            "fax_number": "505-395-9251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 CALLE MEDICO STE 4",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875054761",
            "telephone_number": "813-484-2335",
            "fax_number": "505-395-9251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AQUARIUS MEDICAL & WELLNESS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-04",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A",
        "authorized_official_last_name": "OLIS",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-484-2335",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Fe, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.