| Organization Name: | AVANTI WELLNESS CENTER FLLLP |
| NPI Number: | 1528200029 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RANDI B BRAZER (DIRECTOR OF OPERATIONS) |
| Mailing Address: | 3574 Us 1 S Suite 113 St Augustine |
| State: | FL US |
| Postal Code: | 320866466 |
| Phone Number: | 9047973115 |
| Fax Number: | 9047972915 |
| NPI Enumeration Date: | 03/30/2009 |
| NPI Last Update Date: | 08/18/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |