MEDICARE: FLORIDA COMPLETE WELLNESS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171100000X	Acupuncturist
2	363L00000X	Nurse Practitioner
3	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164448197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA COMPLETE WELLNESS, INC.

Provider Business Mailing Address
First Line	:	3408 W 84TH ST STE 309
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4944
Country	:	US
Telephone Number	:	954-765-6505
Fax Number	:

Provider Business Practice Location Address
First Line	:	3408 W 84TH ST STE 309
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4944
Country	:	US
Telephone Number	:	954-765-6505
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FARRAR VALINE DURO
Credential	:
Telephone Number	:	954-765-6505

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	10/19/2023

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