Provider Demographics
NPI:1376289082
Name:WW WELLNESS ENTERPRISES LLC
Entity Type:Organization
Organization Name:WW WELLNESS ENTERPRISES LLC
Other - Org Name:FOURTH TRIMESTER NP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER/BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WAFE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, WHNP-BC
Authorized Official - Phone:954-228-3676
Mailing Address - Street 1:7901 4TH ST N STE 300
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4399
Mailing Address - Country:US
Mailing Address - Phone:813-344-4534
Mailing Address - Fax:813-543-9657
Practice Address - Street 1:9050 PINES BLVD STE 302
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6422
Practice Address - Country:US
Practice Address - Phone:813-344-4534
Practice Address - Fax:813-543-9657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3132707Medicaid