Provider Demographics
NPI:1386467124
Name:KAKO WELLNESS AND HEALTHCARE MANAGEMENT LLC
Entity type:Organization
Organization Name:KAKO WELLNESS AND HEALTHCARE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP- BC
Authorized Official - Phone:815-867-6242
Mailing Address - Street 1:20815 SW 57TH
Mailing Address - Street 2:
Mailing Address - City:DUNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431
Mailing Address - Country:US
Mailing Address - Phone:815-867-6242
Mailing Address - Fax:
Practice Address - Street 1:1492 HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-2405
Practice Address - Country:US
Practice Address - Phone:815-867-6242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty