Provider Demographics
NPI:1093597262
Name:HOMETOWN WELLNESS LLC
Entity Type:Organization
Organization Name:HOMETOWN WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:HEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:863-634-4218
Mailing Address - Street 1:2201 SW 28TH ST # VILLA84
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-5703
Mailing Address - Country:US
Mailing Address - Phone:863-634-4218
Mailing Address - Fax:
Practice Address - Street 1:1124 S PARROTT AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-5270
Practice Address - Country:US
Practice Address - Phone:863-484-6020
Practice Address - Fax:863-484-6017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty