Intentionally Well, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1476272 Issued in FL

Legal business name

INTENTIONALLY WELL, LLC

Practice address

2100 SE Hillmoor Dr Ste 101
Port St Lucie, FL 34952-8057

Phone

(772) 877-2311

Fax

(772) 249-0638

NPI assigned

Apr 2, 2014

Organization subpart

No

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

Authorized official

Name

Theresa Anne Pinder, APN

Title

Sole Member, Ceo

Phone

(772) 215-9946

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1396396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721347200000",
    "number": "1922426402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 SE HILLMOOR DR STE 101",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349528057",
            "telephone_number": "772-877-2311",
            "fax_number": "772-249-0638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 SE HILLMOOR DR STE 101",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349528057",
            "telephone_number": "772-877-2311",
            "fax_number": "772-249-0638"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3716 SW Moore St",
            "address_purpose": "LOCATION",
            "city": "Palm City",
            "state": "FL",
            "postal_code": "349905647",
            "country_code": "US",
            "telephone_number": "772-215-9946",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTENTIONALLY WELL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-02",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A",
        "authorized_official_last_name": "PINDER",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "SOLE MEMBER, CEO",
        "authorized_official_telephone_number": "772-215-9946",
        "authorized_official_credential": "APN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME69414",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "1476272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1912256538",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Family Nurse Practitioner in Florida

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