| Abundant Life Institute | |
|
2646 Centennial Pl Ste A Tallahassee FL 32308-0573 | |
| (850) 402-6210 | |
| Not Available |
| Full Name | Abundant Life Institute |
|---|---|
| Speciality | Family Medicine |
| Location | 2646 Centennial Pl Ste A, Tallahassee, Florida |
| Authorized Official Name and Position | Brandy C Willis (OWNER) |
| Authorized Official Contact | 8507020300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Abundant Life Institute 2646 Centennial Pl Ste A Tallahassee FL 32308-0573 Ph: () - | Abundant Life Institute 2646 Centennial Pl Ste A Tallahassee FL 32308-0573 Ph: (850) 402-6210 |
| NPI Number | 1407505431 |
|---|---|
| Provider Enumeration Date | 03/18/2022 |
| Last Update Date | 01/07/2023 |
| Medicare PECOS PAC ID | 0345625273 |
|---|---|
| Medicare Enrollment ID | O20220913004206 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407505431 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Brandon D Foutch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184957805 PECOS PAC ID: 1759420813 Enrollment ID: I20091202000506 |
| Provider Name | Brandy Childers Willis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457556268 PECOS PAC ID: 1658404215 Enrollment ID: I20100803000473 |
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