Provider Demographics
NPI:1376289082
Name:WW WELLNESS ENTERPRISES LLC
Entity type:Organization
Organization Name:WW WELLNESS ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WAFE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, WHNP-BC
Authorized Official - Phone:786-371-6092
Mailing Address - Street 1:17113 MIRAMAR PKWY # 4
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4565
Mailing Address - Country:US
Mailing Address - Phone:786-371-6092
Mailing Address - Fax:
Practice Address - Street 1:1805 SW 181ST WAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5222
Practice Address - Country:US
Practice Address - Phone:786-371-6092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No363LP1700XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPerinatalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3132707Medicaid