Healthcare Provider Details

I. General information

NPI: 1427605088
Provider Name (Legal Business Name): GLOBAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 SAWGRASS CORPORATE PARKWAY #447
SUNRISE FL
33323
US

IV. Provider business mailing address

5911 NE 14TH LN APT 506
FORT LAUDERDALE FL
33334-5006
US

V. Phone/Fax

Practice location:
  • Phone: 954-494-0668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANCY NATHALY FONSECCA
Title or Position: NEUROPSYCHOLOGIST
Credential: PSY. D
Phone: 954-494-0668