Healthcare Provider Details

I. General information

NPI: 1093519829
Provider Name (Legal Business Name): THE TOWER RIDGE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 S LAKE STARR BLVD
LAKE WALES FL
33898-7661
US

IV. Provider business mailing address

23781 US HIGHWAY 27 # 139
LAKE WALES FL
33859-7802
US

V. Phone/Fax

Practice location:
  • Phone: 863-855-0047
  • Fax: 888-504-1691
Mailing address:
  • Phone: 863-855-0047
  • Fax: 888-504-1691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DONALD JOHNSON
Title or Position: OWNER
Credential: APRN
Phone: 863-855-0047