Healthcare Provider Details

I. General information

NPI: 1417851627
Provider Name (Legal Business Name): LAUREL DIRECT PRIMARY CARE & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 SPRING HILL DR
SPRING HILL FL
34609-5048
US

IV. Provider business mailing address

13001 SPRING HILL DR
SPRING HILL FL
34609-5048
US

V. Phone/Fax

Practice location:
  • Phone: 239-565-6268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: LORI L WISTLING
Title or Position: OWNER/APRN
Credential: APRN
Phone: 239-565-6268