Iconic Health LLC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

Legal business name

ICONIC HEALTH LLC

Practice address

1898 W Hillsboro Blvd Ste H
Deerfield Beach, FL 33442-1434

Phone

(954) 571-9392

Fax

(954) 289-4888

NPI assigned

May 10, 2021

Organization subpart

No

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

Authorized official

Name

Sarah Ravelli, ARNP

Title

Ceo, Lead Practitioner

Phone

(330) 277-1131

Specialties & licenses 3

Addresses

Electronic endpoints 1

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1620604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621382400000",
    "number": "1700460383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1898 W HILLSBORO BLVD STE H",
            "city": "DEERFIELD BEACH",
            "state": "FL",
            "postal_code": "334421434",
            "telephone_number": "954-571-9392",
            "fax_number": "954-289-4888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1898 W HILLSBORO BLVD STE H",
            "city": "DEERFIELD BEACH",
            "state": "FL",
            "postal_code": "334421434",
            "telephone_number": "954-571-9392",
            "fax_number": "954-289-4888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICONIC HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-10",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A",
        "authorized_official_last_name": "RAVELLI",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "CEO, LEAD PRACTITIONER",
        "authorized_official_telephone_number": "330-277-1131",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.eclinicalworks.com",
            "affiliation": "Y",
            "endpointDescription": "EClinical EMR",
            "affiliationName": "MD Healthcare Margate, LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2730 N State Road 7",
            "city": "Margate",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330635726",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Avionna Nicole Ibarra
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• Ibrahimahmed, D.O., PLLC.
• Icon PT LLC
• Ida Wallace Bennett Family Health Corporation
• Danielle Rae Iglesias
• Gabriel Osiris Iglesias
• Donna Mary Ihle, ARNP
• III Isaias Insurance Inc

• Adult Health Nurse Practitioner in Deerfield Beach, FL
• Providers in Deerfield Beach, FL by specialty
• Adult Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; 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.