Healthcare Provider Details

I. General information

NPI: 1487558870
Provider Name (Legal Business Name): COHVERA PRIMARY CARE & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 ALLEGRA WAY
LUTZ FL
33559-6999
US

IV. Provider business mailing address

23950 TERRACINA CT
LAND O LAKES FL
34639-2840
US

V. Phone/Fax

Practice location:
  • Phone: 813-817-2847
  • Fax:
Mailing address:
  • Phone: 813-817-2847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: JUDYTH MIRANDA-MENDEZ
Title or Position: CEO/OWNER
Credential: APRN
Phone: 813-817-2847