MEDICARE: WELLNESS AND HYDRATION CLINIC, 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	261QF0050X	Non-Surgical Family Planning Clinic/Center
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1831789015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS AND HYDRATION CLINIC, LLC

Provider Business Mailing Address
First Line	:	580 LEXINGTON GREEN LN
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-1026
Country	:	US
Telephone Number	:	407-904-0942
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 LEXINGTON GREEN LN
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-1026
Country	:	US
Telephone Number	:	931-510-7783
Fax Number	:

Authorized Official
Title or Position	:	OWNER / CEO
Name	:	MRS. BIANCA CARROLL
Credential	:	NP
Telephone Number	:	931-510-7783

Provider Enumeration Date	:	01/21/2021
Last Update Date	:	02/25/2026

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