Provider Demographics
NPI:1114321833
Name:TARGET WELLNESS LLC
Entity Type:Organization
Organization Name:TARGET WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ELLERT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:407-473-7545
Mailing Address - Street 1:713 PARK VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-7952
Mailing Address - Country:US
Mailing Address - Phone:407-473-7545
Mailing Address - Fax:352-536-2087
Practice Address - Street 1:713 PARK VALLEY CIR
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-7952
Practice Address - Country:US
Practice Address - Phone:407-473-7545
Practice Address - Fax:352-536-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2166292261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service