Healthcare Provider Details

I. General information

NPI: 1801774799
Provider Name (Legal Business Name): LUNA WELLNESS & PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LINBERRY LN
OCOEE FL
34761-4440
US

IV. Provider business mailing address

1032 E BRANDON BLVD # 3553
BRANDON FL
33511-5509
US

V. Phone/Fax

Practice location:
  • Phone: 407-453-1606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY LOCK
Title or Position: CEO
Credential: NP
Phone: 407-453-1606