Provider Demographics
NPI:1225855562
Name:LOVE, FAITH, WELLNESS, LLC
Entity type:Organization
Organization Name:LOVE, FAITH, WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP, APRN-C
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN-C
Authorized Official - Phone:813-419-7911
Mailing Address - Street 1:11948 CROSS VINE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-4312
Mailing Address - Country:US
Mailing Address - Phone:786-925-0745
Mailing Address - Fax:
Practice Address - Street 1:646 E BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8111
Practice Address - Country:US
Practice Address - Phone:813-419-7911
Practice Address - Fax:813-291-7588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty