Healthcare Provider Details

I. General information

NPI: 1922678853
Provider Name (Legal Business Name): RAPHA HEALTH AND WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 SW 34TH CIR
OCALA FL
34474-3392
US

IV. Provider business mailing address

13 CROSSANDRA DR
HOMOSASSA FL
34446-8416
US

V. Phone/Fax

Practice location:
  • Phone: 904-434-0739
  • Fax:
Mailing address:
  • Phone: 904-434-0739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TAMMY PAULLIN
Title or Position: OWNER
Credential: ARNP
Phone: 904-434-0739