Healthcare Provider Details

I. General information

NPI: 1649064106
Provider Name (Legal Business Name): EAGLE ADULT WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7519 PAULA DR
TAMPA FL
33615-4113
US

IV. Provider business mailing address

7519 PAULA DR
TAMPA FL
33615-4113
US

V. Phone/Fax

Practice location:
  • Phone: 813-397-1311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MERLYS GUTIERREZ
Title or Position: PRESIDENT
Credential:
Phone: 813-397-1311