Provider Demographics
NPI:1518779115
Name:VITAMINISE WELLNEST CLINIC
Entity type:Organization
Organization Name:VITAMINISE WELLNEST CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:689-310-3313
Mailing Address - Street 1:ELIZABETH.HENSON@WELLNESTHCC.COM
Mailing Address - Street 2:437 PANDA PL
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837
Mailing Address - Country:US
Mailing Address - Phone:689-310-3310
Mailing Address - Fax:407-386-3220
Practice Address - Street 1:9753 S ORANGE BLOSSOM TRL STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8998
Practice Address - Country:US
Practice Address - Phone:689-310-2613
Practice Address - Fax:407-386-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty