Provider Demographics
NPI:1902668809
Name:DEFINITIVE BEAUTY L.L.C.
Entity Type:Organization
Organization Name:DEFINITIVE BEAUTY L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERLINE
Authorized Official - Middle Name:DORT
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:AUTONOMOUS ARNP- WHN
Authorized Official - Phone:407-319-5378
Mailing Address - Street 1:3520 AVALON PARK EAST BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7367
Mailing Address - Country:US
Mailing Address - Phone:407-319-5378
Mailing Address - Fax:
Practice Address - Street 1:3520 AVALON PARK EAST BLVD STE 301
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7367
Practice Address - Country:US
Practice Address - Phone:407-319-5378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty