Provider Demographics
NPI:1407686074
Name:SOUTHEASTERN HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:SOUTHEASTERN HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:TOLAR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:205-718-4075
Mailing Address - Street 1:5408 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:FL
Mailing Address - Zip Code:32445-3128
Mailing Address - Country:US
Mailing Address - Phone:689-262-6576
Mailing Address - Fax:689-262-6575
Practice Address - Street 1:5408 10TH ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:FL
Practice Address - Zip Code:32445-3128
Practice Address - Country:US
Practice Address - Phone:689-262-6576
Practice Address - Fax:689-262-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty