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General NPI Number Information
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NPI Number | 1093519829
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Entity Type | Organization
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Legal Business Name | THE TOWER RIDGE GROUP LLC
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 158 S LAKE STARR BLVD
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City | LAKE WALES
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State | FL
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Zip | 33898-7661
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Country | US
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Telephone | 863-855-0047
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Fax | 888-504-1691
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Provider Business Mailing Address
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Address Line | 23781 US HIGHWAY 27 # 139
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City | LAKE WALES
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State | FL
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Zip | 33859-7802
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Country | US
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Telephone | 863-855-0047
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Fax | 888-504-1691
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Authorized Official
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Title or Position | OWNER
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Name | DONALD JOHNSON
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Credential | APRN
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Telephone | 863-855-0047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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