Healthcare Provider Details

I. General information

NPI: 1194325969
Provider Name (Legal Business Name): COGNITIVE HEALTH & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 W DESOTO ST UNIT 8H
CLERMONT FL
34711-2110
US

IV. Provider business mailing address

838 W DESOTO ST UNIT 8H
CLERMONT FL
34711-2110
US

V. Phone/Fax

Practice location:
  • Phone: 352-505-1788
  • Fax: 321-594-7656
Mailing address:
  • Phone: 352-505-1788
  • Fax: 321-594-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHARON ANNA WALKER
Title or Position: REGISTERED AGENT
Credential: ARNP
Phone: 352-223-7779