Healthcare Provider Details

I. General information

NPI: 1356868657
Provider Name (Legal Business Name): 1 HEALTH & WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 W VIRGINIA AVE STE D
TAMPA FL
33607-6310
US

IV. Provider business mailing address

2511 W VIRGINIA AVE STE D
TAMPA FL
33607-6310
US

V. Phone/Fax

Practice location:
  • Phone: 813-252-9240
  • Fax: 813-252-7556
Mailing address:
  • Phone: 813-252-9240
  • Fax: 813-252-7556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberHCC11062
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: HANY D GARBEY MACHIN
Title or Position: PRESIDENT
Credential:
Phone: 813-252-9240