Provider Demographics
NPI:1447500970
Name:EPIPHANY SALON & SPA
Entity type:Organization
Organization Name:EPIPHANY SALON & SPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/COSMOTOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:LUCI
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-898-9036
Mailing Address - Street 1:14700 TAMIAMI TRAIL N.
Mailing Address - Street 2:SUITE #13
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110
Mailing Address - Country:US
Mailing Address - Phone:239-594-1800
Mailing Address - Fax:
Practice Address - Street 1:14700 TAMIAMI TRAIL N.
Practice Address - Street 2:SUITE #13
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110
Practice Address - Country:US
Practice Address - Phone:239-594-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies