Healthcare Provider Details

I. General information

NPI: 1184440836
Provider Name (Legal Business Name): ADVANCED WELLNESS ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 NW 28TH LN STE 4
GAINESVILLE FL
32606-6681
US

IV. Provider business mailing address

4131 NW 28TH LN STE 4
GAINESVILLE FL
32606-6681
US

V. Phone/Fax

Practice location:
  • Phone: 352-681-9652
  • Fax:
Mailing address:
  • Phone: 352-681-9652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MORGAN M.E. BURNS
Title or Position: OWNER
Credential: APRN
Phone: 352-681-9652