Provider Demographics
NPI:1518745223
Name:A1 HEALTH & WELLNESS, LLC
Entity Type:Organization
Organization Name:A1 HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANIQUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-C
Authorized Official - Phone:321-381-8184
Mailing Address - Street 1:1747 EVANS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3869
Mailing Address - Country:US
Mailing Address - Phone:321-381-8184
Mailing Address - Fax:321-343-7009
Practice Address - Street 1:1747 EVANS RD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3869
Practice Address - Country:US
Practice Address - Phone:321-381-8184
Practice Address - Fax:321-343-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty