Provider Demographics
NPI:1053027060
Name:EMBRACE SKIN AND WELLNESS, LLC
Entity type:Organization
Organization Name:EMBRACE SKIN AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/NP
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOLLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:901-651-2059
Mailing Address - Street 1:237 POPLAR VIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3110
Mailing Address - Country:US
Mailing Address - Phone:901-651-2059
Mailing Address - Fax:
Practice Address - Street 1:237 POPLAR VIEW PKWY
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3110
Practice Address - Country:US
Practice Address - Phone:901-651-2059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty