Healthcare Provider Details

I. General information

NPI: 1619785540
Provider Name (Legal Business Name): OCALA HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 SE 25TH LOOP STE 103
OCALA FL
34471-6090
US

IV. Provider business mailing address

12870 W HIGHWAY 40
OCALA FL
34481-1206
US

V. Phone/Fax

Practice location:
  • Phone: 352-810-9387
  • Fax:
Mailing address:
  • Phone: 706-206-2666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA HOWINGTON
Title or Position: OWNER
Credential: APRN
Phone: 706-206-2666