Healthcare Provider Details

I. General information

NPI: 1710404363
Provider Name (Legal Business Name): CENTER FOR HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3117 SPRING GLEN RD STE 407
JACKSONVILLE FL
32207-5906
US

IV. Provider business mailing address

3117 SPRING GLEN RD STE 407
JACKSONVILLE FL
32207-5906
US

V. Phone/Fax

Practice location:
  • Phone: 904-476-1816
  • Fax: 904-518-5927
Mailing address:
  • Phone: 904-476-1816
  • Fax: 904-518-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS668100
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN LAWRENCE SIMONS JR.
Title or Position: OWNER
Credential: DO
Phone: 904-476-1816