Provider Demographics
NPI:1922678853
Name:RAPHA HEALTH AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:RAPHA HEALTH AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULLIN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:904-434-0739
Mailing Address - Street 1:40 SW 12TH STREET
Mailing Address - Street 2:UNIT C101
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471
Mailing Address - Country:US
Mailing Address - Phone:352-421-3200
Mailing Address - Fax:
Practice Address - Street 1:40 SW 12TH STREET
Practice Address - Street 2:UNIT C101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-3447
Practice Address - Country:US
Practice Address - Phone:352-421-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service