Healthcare Provider Details

I. General information

NPI: 1215802749
Provider Name (Legal Business Name): THE WELL MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 N 40TH ST STE 813
TAMPA FL
33610-5204
US

IV. Provider business mailing address

5110 N 40TH ST STE 813
TAMPA FL
33610-5204
US

V. Phone/Fax

Practice location:
  • Phone: 813-294-5510
  • Fax:
Mailing address:
  • Phone: 813-800-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NOSAGHARE OWENS
Title or Position: OWNER
Credential:
Phone: 813-800-6337