=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912718982
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTALWELL HEALTH CLINIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2025
-----------------------------------------------------
Last Update Date | 08/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1425 TUSKAWILLA RD STE 221
-----------------------------------------------------
City | WINTER SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32708-5289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-257-9947
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1425 TUSKAWILLA RD STE 221
-----------------------------------------------------
City | WINTER SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32708-5289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-775-5315
-----------------------------------------------------
Fax | 855-576-5105
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/ CO-OWNER
-----------------------------------------------------
Name | DR. JOSEPH PATRICK JOHNSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 910-257-9947
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------