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General NPI Number Information
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NPI Number | 1871360438
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Entity Type | Organization
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Legal Business Name | METANOIA WELLNESS CARE LLC
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Dates
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Enumeration Date | 12/05/2023
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 1404 TROPICAL OASIS AVE
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City | PLANT CITY
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State | FL
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Zip | 33565-5963
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Country | US
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Telephone | 787-218-6456
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Fax | 813-867-7787
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Provider Business Mailing Address
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Address Line | 1404 TROPICAL OASIS AVE
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City | PLANT CITY
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State | FL
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Zip | 33565-5963
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Country | US
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Telephone | 787-218-6456
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | DR. DEBORAH R CABALLERO RODRIGUEZ
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Credential | APRN FNP-BC
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Telephone | 787-218-6456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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