Provider Demographics
NPI:1336741594
Name:GREATER WELLNESS, LLC
Entity Type:Organization
Organization Name:GREATER WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TUESDAY
Authorized Official - Middle Name:JEWEL
Authorized Official - Last Name:RADD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CRNA
Authorized Official - Phone:813-549-4563
Mailing Address - Street 1:13801 BRUCE B. DOWNS BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613
Mailing Address - Country:US
Mailing Address - Phone:813-549-4563
Mailing Address - Fax:
Practice Address - Street 1:13801 BRUCE B. DOWNS BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613
Practice Address - Country:US
Practice Address - Phone:813-549-4563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty