Provider Demographics
NPI:1003782178
Name:MEDIVANCE HEALING LLC
Entity type:Organization
Organization Name:MEDIVANCE HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CASAS BARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-709-7646
Mailing Address - Street 1:220 NW 38TH PL
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-2715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 NW 38TH PL
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-2715
Practice Address - Country:US
Practice Address - Phone:786-709-7646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty