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General NPI Number Information
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NPI Number | 1801774799
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Entity Type | Organization
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Legal Business Name | LUNA WELLNESS & PRIMARY CARE
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Dates
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Enumeration Date | 08/26/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 300 LINBERRY LN
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City | OCOEE
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State | FL
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Zip | 34761-4440
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Country | US
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Telephone | 407-453-1606
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Fax |
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Provider Business Mailing Address
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Address Line | 1032 E BRANDON BLVD # 3553
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City | BRANDON
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State | FL
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Zip | 33511-5509
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TIFFANY LOCK
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Credential | NP
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Telephone | 407-453-1606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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