Healthcare Provider Details

I. General information

NPI: 1417876053
Provider Name (Legal Business Name): CITY OF SANFORD WELLNESS CENTER POWERED BY WECARE TLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 MEDICAL PLAZA DR STE 205
SANFORD FL
32771-1047
US

IV. Provider business mailing address

1403 MEDICAL PLAZA DR STE 205
SANFORD FL
32771-1047
US

V. Phone/Fax

Practice location:
  • Phone: 689-331-8359
  • Fax: 407-804-2971
Mailing address:
  • Phone: 689-331-8359
  • Fax: 407-804-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTENE SUMMERS DENTLER
Title or Position: CLINICAL TRAINING & QA MANAGER
Credential: BSN RN
Phone: 256-684-7273