Provider Demographics
NPI:1134705221
Name:ADVANCED PROVDER HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:ADVANCED PROVDER HEALTH & WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:239-220-7828
Mailing Address - Street 1:4085 HANCOCK BRIDGE PKWY STE 112-181
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-7219
Mailing Address - Country:US
Mailing Address - Phone:239-220-7828
Mailing Address - Fax:239-217-9398
Practice Address - Street 1:9575 SW 99TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-6088
Practice Address - Country:US
Practice Address - Phone:352-363-1117
Practice Address - Fax:352-329-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-20
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care