Provider Demographics
NPI:1194690545
Name:MINI HEALTH CLINIC KISSIMMEE LLC
Entity type:Organization
Organization Name:MINI HEALTH CLINIC KISSIMMEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRESHA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:689-263-3351
Mailing Address - Street 1:318 N JOHN YOUNG PKWY STE 5
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4927
Mailing Address - Country:US
Mailing Address - Phone:352-227-3000
Mailing Address - Fax:352-505-7738
Practice Address - Street 1:318 N JOHN YOUNG PKWY STE 5
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4927
Practice Address - Country:US
Practice Address - Phone:352-227-3000
Practice Address - Fax:352-505-7738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-07
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service