Provider Demographics
NPI:1619410081
Name:CENTRAL FLORIDA WELLNESS
Entity Type:Organization
Organization Name:CENTRAL FLORIDA WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNE
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-226-2993
Mailing Address - Street 1:8081 TURKEY LAKE RD STE 650
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7321
Mailing Address - Country:US
Mailing Address - Phone:407-226-2993
Mailing Address - Fax:407-226-2996
Practice Address - Street 1:8081 TURKEY LAKE RD STE 650
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7321
Practice Address - Country:US
Practice Address - Phone:407-226-2993
Practice Address - Fax:407-226-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty