Provider Demographics
NPI:1609484336
Name:RW FAMILY PRACTICE & PREVENTIVE CARE, LLC.
Entity Type:Organization
Organization Name:RW FAMILY PRACTICE & PREVENTIVE CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN, FNP
Authorized Official - Prefix:
Authorized Official - First Name:WILNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DASTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-516-1203
Mailing Address - Street 1:6735 CONROY RD STE 418
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3566
Mailing Address - Country:US
Mailing Address - Phone:407-420-7374
Mailing Address - Fax:407-271-8411
Practice Address - Street 1:6735 CONROY RD STE 418
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3566
Practice Address - Country:US
Practice Address - Phone:407-420-7374
Practice Address - Fax:407-271-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty