Healthcare Provider Details

I. General information

NPI: 1992693121
Provider Name (Legal Business Name): WILLOWS WELLNESS COACHING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4522 W VILLAGE DR UNIT 1438
TAMPA FL
33624-3429
US

IV. Provider business mailing address

4522 W VILLAGE DR UNIT 1438
TAMPA FL
33624-3429
US

V. Phone/Fax

Practice location:
  • Phone: 813-419-2574
  • Fax:
Mailing address:
  • Phone: 813-419-2574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: TORI WILLOWS
Title or Position: HEALTH & WELLNESS COACH
Credential: LPN, NBC-HWC
Phone: 813-419-2574