Wellness360 Primary Care | |
1700 Se Hillmoor Dr Ste 305 Port Saint Lucie FL 34952-7536 | |
(772) 292-8188 | |
Not Available |
Full Name | Wellness360 Primary Care |
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Speciality | Internal Medicine |
Location | 1700 Se Hillmoor Dr Ste 305, Port Saint Lucie, Florida |
Authorized Official Name and Position | Yohanna Deno (OWNER) |
Authorized Official Contact | 7646702685 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Wellness360 Primary Care 1700 Se Hillmoor Dr Ste 305 Port Saint Lucie FL 34952-7536 Ph: () - | Wellness360 Primary Care 1700 Se Hillmoor Dr Ste 305 Port Saint Lucie FL 34952-7536 Ph: (772) 292-8188 |
NPI Number | 1154172773 |
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Provider Enumeration Date | 04/01/2024 |
Last Update Date | 04/01/2024 |
Medicare PECOS PAC ID | 1052751674 |
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Medicare Enrollment ID | O20240430002706 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154172773 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Yohanna Deno |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1700050275 PECOS PAC ID: 4284805805 Enrollment ID: I20131009000276 |
Provider Name | Massiel Morales |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1942823067 PECOS PAC ID: 9234545666 Enrollment ID: I20210310001474 |
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