Healthcare Provider Details

I. General information

NPI: 1295672780
Provider Name (Legal Business Name): TWO DOORS HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 WILLIAMSBURG PARK BLVD UNIT 4
JACKSONVILLE FL
32257-9200
US

IV. Provider business mailing address

PO BOX 600865
JACKSONVILLE FL
32260-0865
US

V. Phone/Fax

Practice location:
  • Phone: 904-217-8952
  • Fax: 682-201-2130
Mailing address:
  • Phone: 904-907-7768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHRISTELLE TAKOU OBEN
Title or Position: OWNER
Credential: APRN
Phone: 904-217-8952