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General NPI Number Information
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NPI Number | 1831789015
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Entity Type | Organization
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Legal Business Name | WELLNESS AND HYDRATION CLINIC, LLC
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Dates
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Enumeration Date | 01/21/2021
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Last Update Date | 02/25/2026
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Provider Practice Location Address
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Address Line | 580 LEXINGTON GREEN LN
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City | SANFORD
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State | FL
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Zip | 32771-1026
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Country | US
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Telephone | 931-510-7783
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Fax |
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Provider Business Mailing Address
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Address Line | 580 LEXINGTON GREEN LN
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City | SANFORD
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State | FL
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Zip | 32771-1026
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Country | US
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Telephone | 407-904-0942
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Fax |
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Authorized Official
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Title or Position | OWNER / CEO
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Name | MRS. BIANCA CARROLL
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Credential | NP
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Telephone | 931-510-7783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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