Provider Demographics
NPI:1881572238
Name:DIVINE WELLNESS PARTNERS, LLC
Entity type:Organization
Organization Name:DIVINE WELLNESS PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C, BCPA
Authorized Official - Phone:321-364-3758
Mailing Address - Street 1:2412 IRWIN ST STE 377
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-7316
Mailing Address - Country:US
Mailing Address - Phone:321-364-3758
Mailing Address - Fax:
Practice Address - Street 1:2412 IRWIN ST STE 377
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-7316
Practice Address - Country:US
Practice Address - Phone:321-364-3758
Practice Address - Fax:833-635-8722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-25
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center