Healthcare Provider Details

I. General information

NPI: 1750730024
Provider Name (Legal Business Name): CENTER FOR WELLNESS AND FAMILY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 13TH ST 4808/577 UNIT A
SAINT CLOUD FL
34769-4501
US

IV. Provider business mailing address

PO BOX 4100
BARBOURSVILLE WV
25504-4100
US

V. Phone/Fax

Practice location:
  • Phone: 407-846-8600
  • Fax: 407-846-2301
Mailing address:
  • Phone: 304-955-6200
  • Fax: 304-399-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number9244881
License Number StateFL

VIII. Authorized Official

Name: YVONNE BOSTON
Title or Position: OWNER
Credential: APRN
Phone: 407-846-8600