Provider Demographics
NPI:1003656919
Name:ADVANCED PRACTICE AND WELLNESS LLC
Entity type:Organization
Organization Name:ADVANCED PRACTICE AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-612-0173
Mailing Address - Street 1:1790 WATERSIDE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-9206
Mailing Address - Country:US
Mailing Address - Phone:256-612-0173
Mailing Address - Fax:
Practice Address - Street 1:1790 WATERSIDE OAKS DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-9206
Practice Address - Country:US
Practice Address - Phone:256-612-0173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily