Provider Demographics
NPI:1205368073
Name:CENTRAL FLORIDA WELLNESS LLC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-226-2993
Mailing Address - Street 1:7932 W SAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7263
Mailing Address - Country:US
Mailing Address - Phone:407-226-2993
Mailing Address - Fax:407-226-2996
Practice Address - Street 1:1850 W FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4559
Practice Address - Country:US
Practice Address - Phone:407-226-2993
Practice Address - Fax:407-226-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty