MEDICARE: EXCEPTIONAL HEALTH WALK-IN PRIMARY CARE 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	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1568396687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEPTIONAL HEALTH WALK-IN PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	940 RIDGE HAVEN DR
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-7021
Country	:	US
Telephone Number	:	727-325-3405
Fax Number	:

Provider Business Practice Location Address
First Line	:	6014 N 40TH ST STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-3800
Country	:	US
Telephone Number	:	727-325-3405
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KERRY-ANN A DALEY
Credential	:	APRN
Telephone Number	:	727-325-3405

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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