Provider Demographics
NPI:1568785384
Name:ADVANTAGE WELLNESS SERVICES
Entity Type:Organization
Organization Name:ADVANTAGE WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:855-297-8326
Mailing Address - Street 1:5510 SW 41ST BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4977
Mailing Address - Country:US
Mailing Address - Phone:855-297-8326
Mailing Address - Fax:888-503-7832
Practice Address - Street 1:5510 SW 41ST BLVD
Practice Address - Street 2:STE 202
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4977
Practice Address - Country:US
Practice Address - Phone:855-297-8326
Practice Address - Fax:888-503-7832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty