Healthcare Provider Details

I. General information

NPI: 1770409674
Provider Name (Legal Business Name): DR. WALKER LIFESTYLE MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12555 ORANGE DR STE 227
DAVIE FL
33330-4304
US

IV. Provider business mailing address

12555 ORANGE DR STE 227
DAVIE FL
33330-4304
US

V. Phone/Fax

Practice location:
  • Phone: 954-862-1706
  • Fax: 954-405-8915
Mailing address:
  • Phone: 954-862-1706
  • Fax: 954-405-8915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JANICE WALKER
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 954-862-1706