The Center for Functional Aesthetic and Anti Aging Medicine Inc
NPI 1508682089 · Internal Medicine Physician · Winter Haven, FL
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
The Center for Functional Aesthetic and Anti Aging Medicine Inc is a Internal Medicine Physician organization in Winter Haven, FL (NPI 1508682089).
Provider details
- NPI number
- 1508682089
- Entity type
- Organization
- Primary specialty
- Internal Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Danice Blaise, Chief Executive Officer, Owner(954) 681-0068
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Naturopath175F00000X
Other Service Providers
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
1 yr in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2024-11-29
- Last updated
- 2024-11-29
- Certified
- 2024-11-28
Frequently asked questions
- What is The Center for Functional Aesthetic and Anti Aging Medicine Inc's NPI number?
- The Center for Functional Aesthetic and Anti Aging Medicine Inc's National Provider Identifier (NPI) is 1508682089, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is The Center for Functional Aesthetic and Anti Aging Medicine Inc?
- The Center for Functional Aesthetic and Anti Aging Medicine Inc is classified in the NPPES registry as Internal Medicine Physician (Allopathic & Osteopathic Physicians).
- Where is The Center for Functional Aesthetic and Anti Aging Medicine Inc located?
- The Center for Functional Aesthetic and Anti Aging Medicine Inc's practice location on file with NPPES is 571 Avenue K Se, Winter Haven, FL 33880-4215.
- What is The Center for Functional Aesthetic and Anti Aging Medicine Inc's phone number?
- The practice phone number listed in the NPPES registry for The Center for Functional Aesthetic and Anti Aging Medicine Inc is (407) 440-0708.
- Does The Center for Functional Aesthetic and Anti Aging Medicine Inc accept Medicare?
- The Center for Functional Aesthetic and Anti Aging Medicine Inc is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for The Center for Functional Aesthetic and Anti Aging Medicine Inc?
- The authorized official listed on The Center for Functional Aesthetic and Anti Aging Medicine Inc's NPPES record is Danice Blaise, Chief Executive Officer, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is The Center for Functional Aesthetic and Anti Aging Medicine Inc's NPI active?
- Yes — The Center for Functional Aesthetic and Anti Aging Medicine Inc's NPI (1508682089) is active in the NPPES registry as of the last update on 2024-11-29.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.