Healthcare Provider Details

I. General information

NPI: 1134705221
Provider Name (Legal Business Name): ADVANCED PROVDER HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9575 SW 99TH PL
GAINESVILLE FL
32608-6088
US

IV. Provider business mailing address

4085 HANCOCK BRIDGE PKWY STE 112-181
NORTH FORT MYERS FL
33903-7219
US

V. Phone/Fax

Practice location:
  • Phone: 352-363-1117
  • Fax: 352-329-4300
Mailing address:
  • Phone: 239-220-7828
  • Fax: 239-217-9398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA CROSS
Title or Position: MGR
Credential: APRN
Phone: 239-220-7828