Healthcare Provider Details

I. General information

NPI: 1326755372
Provider Name (Legal Business Name): MY WELLNESS NP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14707 S DIXIE HWY STE 402E
PALMETTO BAY FL
33176-7960
US

IV. Provider business mailing address

14707 S DIXIE HWY STE 402E
PALMETTO BAY FL
33176-7960
US

V. Phone/Fax

Practice location:
  • Phone: 305-528-3040
  • Fax:
Mailing address:
  • Phone: 305-528-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: FANYA TOKWAULU
Title or Position: FOUNDER PROVIDER
Credential: APRN FNP BC
Phone: 305-562-7498