MEDICARE: CENTRAL FLORIDA WELLNESS

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
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1477419190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL FLORIDA WELLNESS

Provider Business Mailing Address
First Line	:	3202 W KENNEDY BLVD STE 2
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3245
Country	:	US
Telephone Number	:	407-226-2993
Fax Number	:

Provider Business Practice Location Address
First Line	:	3202 W KENNEDY BLVD STE 2
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3245
Country	:	US
Telephone Number	:	407-226-2993
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN T SHORTLY
Credential	:
Telephone Number	:	863-559-3434

Provider Enumeration Date	:	12/26/2025
Last Update Date	:	12/26/2025

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Directions to “CENTRAL FLORIDA WELLNESS ” Practice Location

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