Healthcare Provider Details

I. General information

NPI: 1851858161
Provider Name (Legal Business Name): GRACE HEALTH AND WELLNESS SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W NOBLE AVE
WILLISTON FL
32696-2034
US

IV. Provider business mailing address

1039 NE 25TH ST
OCALA FL
34470-3788
US

V. Phone/Fax

Practice location:
  • Phone: 352-528-3736
  • Fax: 352-528-3211
Mailing address:
  • Phone: 352-622-2681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: LEAMARIE KALFS
Title or Position: OWNER
Credential: NP
Phone: 352-528-3736