Provider Demographics
NPI:1891416301
Name:FORWARD WELLNESS, LLC
Entity Type:Organization
Organization Name:FORWARD WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:850-343-5800
Mailing Address - Street 1:42 EGRET ST N
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-1411
Mailing Address - Country:US
Mailing Address - Phone:850-343-5800
Mailing Address - Fax:850-343-5700
Practice Address - Street 1:1616 CRAWFORDVILLE HWY STE D
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-0188
Practice Address - Country:US
Practice Address - Phone:850-343-5800
Practice Address - Fax:850-343-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty