Provider Demographics
NPI:1285867408
Name:ESSENTIAL WELLNESS FOR LIFE, LLC
Entity Type:Organization
Organization Name:ESSENTIAL WELLNESS FOR LIFE, LLC
Other - Org Name:ESSENTIAL WELLNESS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-507-7100
Mailing Address - Street 1:34754 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-2120
Mailing Address - Country:US
Mailing Address - Phone:727-507-7100
Mailing Address - Fax:727-507-7137
Practice Address - Street 1:34754 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2120
Practice Address - Country:US
Practice Address - Phone:727-507-7100
Practice Address - Fax:727-507-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82894261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care