MEDICARE: HORMONE HEALTH AND WELLNESS

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	261QH0100X	Health Service Clinic/Center	ME106629	FL

General Provider Information

NPI Number	:	1144690868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HORMONE HEALTH AND WELLNESS

Provider Business Mailing Address
First Line	:	444 SW ALACHUA AVE
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-5213
Country	:	US
Telephone Number	:	386-719-5656
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 SW ALACHUA AVE
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-5213
Country	:	US
Telephone Number	:	386-719-5656
Fax Number	:	386-719-5654

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SEAN P MOORE
Credential	:	RN AIS BC
Telephone Number	:	386-719-5656

Provider Enumeration Date	:	10/07/2015
Last Update Date	:	10/07/2015

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Directions to “HORMONE HEALTH AND WELLNESS ” Practice Location

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