Provider Demographics
NPI:1437046935
Name:SERENITY FAMILY HEALTH LLC
Entity type:Organization
Organization Name:SERENITY FAMILY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:850-272-8520
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-0245
Mailing Address - Country:US
Mailing Address - Phone:850-272-8520
Mailing Address - Fax:
Practice Address - Street 1:1431 WALKER RD
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32440-7809
Practice Address - Country:US
Practice Address - Phone:850-272-8520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty