Healthcare Provider Details

I. General information

NPI: 1932064870
Provider Name (Legal Business Name): THE PEACE WORKOUT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 MAHAFFEY CIRCLE
LAKELAND FL
33811
US

IV. Provider business mailing address

19046 BRUCE B DOWNS BLVD # 201
TAMPA FL
33647-2434
US

V. Phone/Fax

Practice location:
  • Phone: 813-787-1280
  • Fax:
Mailing address:
  • Phone: 813-787-1280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADEBOLA J ADESHINA
Title or Position: NUTRITIONIST - WELLNESS COACH
Credential:
Phone: 813-787-1280