Healthcare Provider Details

I. General information

NPI: 1790695344
Provider Name (Legal Business Name): LUNA FAMILY HEALTH & WELLNESS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S FRENCH AVE STE 1004
SANFORD FL
32771-4253
US

IV. Provider business mailing address

2200 S FRENCH AVE STE 1004
SANFORD FL
32771-4253
US

V. Phone/Fax

Practice location:
  • Phone: 386-465-4543
  • Fax:
Mailing address:
  • Phone: 386-465-4543
  • Fax:

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: TIFFANY VARELA KHAN
Title or Position: OWNER
Credential: APRN
Phone: 407-590-7973