Healthcare Provider Details

I. General information

NPI: 1881185494
Provider Name (Legal Business Name): WELLSPRING HEALTH - DAYTONA BEACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 WESTMORELAND RD
DAYTONA BEACH FL
32114-1626
US

IV. Provider business mailing address

2275 N VOLUSIA AVE STE 100
ORANGE CITY FL
32763-2833
US

V. Phone/Fax

Practice location:
  • Phone: 386-775-6879
  • Fax: 386-775-0307
Mailing address:
  • Phone: 386-775-6879
  • Fax: 386-775-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH11028
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VERONICA BERRIOS
Title or Position: CLINIC MANAGER
Credential:
Phone: 386-775-6879