Provider Demographics
NPI:1912317843
Name:WELLNESS HEALTH PROVIDERS,APN.HOUSE CALLS,LLC.
Entity Type:Organization
Organization Name:WELLNESS HEALTH PROVIDERS,APN.HOUSE CALLS,LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:352-245-2288
Mailing Address - Street 1:6262 SE 121ST PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-5215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6262 SE 121ST PL
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-5215
Practice Address - Country:US
Practice Address - Phone:352-245-2288
Practice Address - Fax:800-385-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1473752363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty