Healthcare Provider Details

I. General information

NPI: 1083457345
Provider Name (Legal Business Name): TJ HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 SUWANNEE AVE NW
BRANFORD FL
32008-3265
US

IV. Provider business mailing address

400 SW 1ST AVE UNIT 1179
OCALA FL
34478-7748
US

V. Phone/Fax

Practice location:
  • Phone: 352-421-5694
  • Fax: 352-421-5226
Mailing address:
  • Phone: 352-421-5694
  • Fax: 877-673-0827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TANYA MARIE JOHNSON
Title or Position: OWNER
Credential: APRN
Phone: 352-421-5694