1255287421 NPI number — AZUREE AESTHETICS & SKIN CARE SPECIALISTS, LLC

Table of content: ARLETIS DAYANA ESPINOSA ORTIZ (NPI 1629826078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255287421 NPI number — AZUREE AESTHETICS & SKIN CARE SPECIALISTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AZUREE AESTHETICS & SKIN CARE SPECIALISTS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255287421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
304 3RD ST SW STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER HAVEN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33880-3409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-529-6899
Provider Business Mailing Address Fax Number:
863-225-1148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 3RD ST SW STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER HAVEN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33880-3409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-529-6899
Provider Business Practice Location Address Fax Number:
863-225-1148
Provider Enumeration Date:
03/09/2026

Additional Information

Authorized Official

Authorized Official Last Name:
SHORT-RUSSELL
Authorized Official First Name:
MELINDA
Authorized Official Middle Name:
RENE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
863-259-6807

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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