Provider Demographics
NPI:1619776374
Name:PEACE HEALING AND WELLNESS LLC
Entity type:Organization
Organization Name:PEACE HEALING AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-671-0258
Mailing Address - Street 1:1650 S DIXIE HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-7461
Mailing Address - Country:US
Mailing Address - Phone:954-671-0258
Mailing Address - Fax:
Practice Address - Street 1:1650 S DIXIE HWY STE 203
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-7461
Practice Address - Country:US
Practice Address - Phone:954-671-0258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-13
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty