Provider Demographics
NPI:1275365066
Name:LIVE WELL DPC
Entity type:Organization
Organization Name:LIVE WELL DPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:941-529-7770
Mailing Address - Street 1:1528 S TUTTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2607
Mailing Address - Country:US
Mailing Address - Phone:941-529-7770
Mailing Address - Fax:941-529-7775
Practice Address - Street 1:1528 S TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2607
Practice Address - Country:US
Practice Address - Phone:941-529-7770
Practice Address - Fax:941-529-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care