Provider Demographics
NPI:1952298747
Name:ATLANTIC WELLNESS
Entity type:Organization
Organization Name:ATLANTIC WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNEERE
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:KORE
Authorized Official - Last Name:DARLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-313-4861
Mailing Address - Street 1:175 E NASA BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1945
Mailing Address - Country:US
Mailing Address - Phone:321-805-3700
Mailing Address - Fax:
Practice Address - Street 1:175 E NASA BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1945
Practice Address - Country:US
Practice Address - Phone:321-805-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care