Provider Demographics
NPI:1033976634
Name:ALIVE AND WELL HEALTHCARE LLC
Entity type:Organization
Organization Name:ALIVE AND WELL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ACEVEDO SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:407-433-0993
Mailing Address - Street 1:2200 S BAY ST STE A
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6334
Mailing Address - Country:US
Mailing Address - Phone:407-433-0993
Mailing Address - Fax:
Practice Address - Street 1:2200 S BAY ST STE A
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6334
Practice Address - Country:US
Practice Address - Phone:407-433-0993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty