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General NPI Number Information
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NPI Number | 1861165003
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Entity Type | Organization
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Legal Business Name | PREMIER HEALTH & WELLNESS CENTER OF CENTRAL FLORIDA LLC
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Dates
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Enumeration Date | 07/25/2021
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Last Update Date | 07/25/2021
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Provider Practice Location Address
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Address Line | 415 E MAIN ST STE 212
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City | BARTOW
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State | FL
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Zip | 33830-4703
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Country | US
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Telephone | 321-297-2737
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Fax | 877-797-7978
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Provider Business Mailing Address
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Address Line | PO BOX 705
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City | CLARCONA
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State | FL
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Zip | 32710-0705
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Country | US
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Telephone | 321-297-2737
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Fax | 877-797-7978
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Authorized Official
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Title or Position | OWNER
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Name | NETRENA WILSON
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Credential |
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Telephone | 321-297-2737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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