Healthcare Provider Details

I. General information

NPI: 1528994860
Provider Name (Legal Business Name): MADISON WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20311 CENTRAL AVE W
BLOUNTSTOWN FL
32424-1947
US

IV. Provider business mailing address

14712 NW STATE ROAD 20
BRISTOL FL
32321-3744
US

V. Phone/Fax

Practice location:
  • Phone: 850-674-8888
  • Fax:
Mailing address:
  • Phone: 850-509-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: