Healthcare Provider Details

I. General information

NPI: 1356098289
Provider Name (Legal Business Name): DIRECT CARE AND WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24502 MALVERN ST
BROOKSVILLE FL
34601-4928
US

IV. Provider business mailing address

24502 MALVERN ST
BROOKSVILLE FL
34601-4928
US

V. Phone/Fax

Practice location:
  • Phone: 813-997-6265
  • Fax: 949-222-2843
Mailing address:
  • Phone: 813-997-6265
  • Fax: 949-222-2843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. APRYL H MOSS
Title or Position: PRESIDENT
Credential: DNP, APRN, FNP-C
Phone: 813-997-6265