Provider Demographics
NPI:1750730024
Name:CENTER FOR WELLNESS AND FAMILY HEALTH LLC
Entity type:Organization
Organization Name:CENTER FOR WELLNESS AND FAMILY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:407-846-8600
Mailing Address - Street 1:PO BOX 4100
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-4100
Mailing Address - Country:US
Mailing Address - Phone:304-955-6200
Mailing Address - Fax:304-399-2526
Practice Address - Street 1:523 13TH ST
Practice Address - Street 2:4808/577 UNIT A
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4501
Practice Address - Country:US
Practice Address - Phone:407-846-8600
Practice Address - Fax:407-846-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9244881363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty