MEDICARE: ADVANCED WELLNESS CONSULTANTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114515186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED WELLNESS CONSULTANTS LLC

Provider Business Mailing Address
First Line	:	2822 N UNIVERSITY DR
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33322-2450
Country	:	US
Telephone Number	:	754-223-2321
Fax Number	:	954-252-4026

Provider Business Practice Location Address
First Line	:	2822 N UNIVERSITY DR
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33322-2450
Country	:	US
Telephone Number	:	754-223-2321
Fax Number	:	954-252-4026

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PEDRO E ROSAS SANTIAGO
Credential	:	NP
Telephone Number	:	786-447-1570

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	08/14/2025

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