Healthcare Provider Details

I. General information

NPI: 1770411647
Provider Name (Legal Business Name): TGL PRECISION WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 N CLYDE MORRIS BLVD STE 120
DAYTONA BEACH FL
32117-5519
US

IV. Provider business mailing address

205 EAGLE HARBOR WAY
DAYTONA BEACH FL
32124-1023
US

V. Phone/Fax

Practice location:
  • Phone: 386-363-8300
  • Fax:
Mailing address:
  • Phone: 386-363-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAYANNA LAWLOR
Title or Position: OWNER
Credential: FNP-BC
Phone: 386-363-8300