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General NPI Number Information
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NPI Number | 1346937737
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Entity Type | Organization
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Legal Business Name | J.C. WELLNESS & PRIMARY CARE, LLC
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 616 E ALTAMONTE DR STE 203
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-4810
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Country | US
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Telephone | 407-701-7356
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Fax | 407-598-8830
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Provider Business Mailing Address
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Address Line | 3718 GREYTHORNE LOOP
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City | OVIEDO
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State | FL
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Zip | 32765-9054
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Country | US
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Telephone | 407-701-7356
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/ OWNER
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Name | KENISHA T. WOOD
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Credential | APRN
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Telephone | 631-219-8520
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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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