Provider Demographics
NPI:1053183228
Name:PRACTICAL MAGIC HEALTH & WELLNESS
Entity type:Organization
Organization Name:PRACTICAL MAGIC HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HANSEN VELA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:772-268-7757
Mailing Address - Street 1:152 ROSEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8835
Mailing Address - Country:US
Mailing Address - Phone:772-370-4899
Mailing Address - Fax:
Practice Address - Street 1:152 ROSEWOOD CIR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8835
Practice Address - Country:US
Practice Address - Phone:772-370-4899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty