Healthcare Provider Details

I. General information

NPI: 1225747629
Provider Name (Legal Business Name): WELLFORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2049 NE 15TH TER
GAINESVILLE FL
32609-3978
US

IV. Provider business mailing address

5764 N ORANGE BLOSSOM TRL
ORLANDO FL
32810-1023
US

V. Phone/Fax

Practice location:
  • Phone: 352-359-6726
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MARQUIS RICHARDS
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: RN
Phone: 352-359-6726