Healthcare Provider Details

I. General information

NPI: 1831861269
Provider Name (Legal Business Name): BLUEWATER WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 CHESTNUT ST
CLERMONT FL
34711-3020
US

IV. Provider business mailing address

234 CHESTNUT ST
CLERMONT FL
34711-3020
US

V. Phone/Fax

Practice location:
  • Phone: 407-347-7142
  • Fax: 407-588-0854
Mailing address:
  • Phone: 407-347-7142
  • Fax: 407-588-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JASON B MEYER
Title or Position: MANAGING DIRECTOR
Credential: APRN
Phone: 407-341-9935