=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487558870
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COHVERA PRIMARY CARE & WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2026
-----------------------------------------------------
Last Update Date | 10/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2831 ALLEGRA WAY
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33559-6999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-817-2847
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23950 TERRACINA CT
-----------------------------------------------------
City | LAND O LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34639-2840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-817-2847
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | JUDYTH MIRANDA-MENDEZ
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 813-817-2847
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------