=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376256685
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEAL SIMPLY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2023
-----------------------------------------------------
Last Update Date | 01/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1317 EDGEWATER DR # 5748
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32804-6350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-617-9426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1317 EDGEWATER DR # 5748
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32804-6350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-617-9426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER/OWNER
-----------------------------------------------------
Name | MISS AKILAH TUNSILL
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 407-617-9426
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------