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NPI Code Detail

MEDICARE: HERITAGE HEALTH AND WELLNESS CLINIC LLC

MEDICARE: HERITAGE HEALTH AND WELLNESS CLINIC LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1477220408
Entity Type Code : Organization
Provider Name (Legal Business Name) : HERITAGE HEALTH AND WELLNESS CLINIC LLC
Provider Business Mailing Address
First Line : 8051 N TAMIAMI TRL STE E6
Second Line :
City : SARASOTA
State : FL
Zip : 34243-2067
Country : US
Telephone Number : 352-283-6110
Fax Number :
Provider Business Practice Location Address
First Line : 8051 N TAMIAMI TRL STE E6
Second Line :
City : SARASOTA
State : FL
Zip : 34243-2067
Country : US
Telephone Number : 352-283-6110
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DANIELLE DODDS
Credential :
Telephone Number : 352-283-6110
Provider Enumeration Date : 08/26/2021
Last Update Date : 08/26/2021

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