Provider Demographics
NPI:1437973427
Name:ABUNDANT HARVEST HEALTH AND HEALING, LLC
Entity type:Organization
Organization Name:ABUNDANT HARVEST HEALTH AND HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-FNP
Authorized Official - Phone:727-342-0209
Mailing Address - Street 1:4905 34TH ST S # 449
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-4511
Mailing Address - Country:US
Mailing Address - Phone:727-342-0209
Mailing Address - Fax:
Practice Address - Street 1:1015 GOLDEN SHINER AVE
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-3309
Practice Address - Country:US
Practice Address - Phone:727-342-0209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty