Healthcare Provider Details

I. General information

NPI: 1700716065
Provider Name (Legal Business Name): MJA WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 W SUNRISE BLVD STE 115
PLANTATION FL
33313-6801
US

IV. Provider business mailing address

6022 NW 91ST WAY STE 119
TAMARAC FL
33321-4100
US

V. Phone/Fax

Practice location:
  • Phone: 954-479-0430
  • Fax: 954-934-9948
Mailing address:
  • Phone: 954-479-0430
  • Fax: 954-934-9948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MINNETTE ADDERLY
Title or Position: PMHNP
Credential:
Phone: 954-479-0430