Healthcare Provider Details

I. General information

NPI: 1609494079
Provider Name (Legal Business Name): BALANCE HEALTH AND WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2020
Last Update Date: 07/11/2020
Certification Date: 07/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2469 GLENRIDGE DR
SPRING HILL FL
34609-3933
US

IV. Provider business mailing address

2469 GLENRIDGE DR
SPRING HILL FL
34609-3933
US

V. Phone/Fax

Practice location:
  • Phone: 352-835-2938
  • Fax:
Mailing address:
  • Phone: 352-835-2938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA SPADAFORA
Title or Position: MANAGER
Credential:
Phone: 352-942-3824