Provider Demographics
NPI:1396638755
Name:DYNAMIC HEALTH CONCEPTS
Entity type:Organization
Organization Name:DYNAMIC HEALTH CONCEPTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BENET
Authorized Official - Middle Name:
Authorized Official - Last Name:FANFAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-568-5728
Mailing Address - Street 1:131 W WASHINGTON ST 61
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34755
Mailing Address - Country:US
Mailing Address - Phone:561-568-5728
Mailing Address - Fax:
Practice Address - Street 1:131 W WASHINGTON ST 61
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34755
Practice Address - Country:US
Practice Address - Phone:561-568-5728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty