Healthcare Provider Details

I. General information

NPI: 1285102152
Provider Name (Legal Business Name): NAYWY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 09/08/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 VONDERBURG DR STE 104
BRANDON FL
33511-6047
US

IV. Provider business mailing address

510 VONDERBURG DR STE 104
BRANDON FL
33511-6047
US

V. Phone/Fax

Practice location:
  • Phone: 813-641-4040
  • Fax: 813-845-0636
Mailing address:
  • Phone: 813-641-4040
  • Fax: 813-845-0636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY COONS
Title or Position: OWNER
Credential:
Phone: 404-805-3791