Provider Demographics
NPI:1336887694
Name:BEYOND WELLNESS HEALTHCARE LLC
Entity Type:Organization
Organization Name:BEYOND WELLNESS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:863-266-4517
Mailing Address - Street 1:145 AVENUE G SW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3435
Mailing Address - Country:US
Mailing Address - Phone:863-266-4517
Mailing Address - Fax:888-464-0733
Practice Address - Street 1:145 AVENUE G SW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3435
Practice Address - Country:US
Practice Address - Phone:863-266-4517
Practice Address - Fax:888-464-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115299600Medicaid
FL0374146OtherCIGNA
FL1003226747OtherMOLINA
FL112190800Medicaid
FL915L1OtherBCBS
FL1003226747OtherHUMANA
FL1003226747OtherSUNSHINE
FLPDZ000000221780OtherAETNA BETTER HEALTH
FLNH6OYOtherBCBS
FL1003226747OtherAMBETTER
FL1037820OtherAVMED
FL024324000Medicaid
FL1634237OtherSTAYWELL
FL414851OtherAVMED