MEDICARE: CENTRAL PARK WELLNESS CLINIC

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
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1356027221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL PARK WELLNESS CLINIC

Provider Business Mailing Address
First Line	:	1713 W OAK RIDGE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1713 W OAK RIDGE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809
Country	:	US
Telephone Number	:	407-240-6288
Fax Number	:	407-438-7450

Authorized Official
Title or Position	:	OWNER
Name	:	PHUONG TRAN
Credential	:	APRN
Telephone Number	:	407-580-5453

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	08/22/2025

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