Provider Demographics
NPI:1588499883
Name:KAP WELLNESS CENTER INC
Entity type:Organization
Organization Name:KAP WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, MSN
Authorized Official - Phone:863-875-6063
Mailing Address - Street 1:7500 CYPRESS GARDENS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3200
Mailing Address - Country:US
Mailing Address - Phone:863-875-6063
Mailing Address - Fax:863-875-6063
Practice Address - Street 1:7500 CYPRESS GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-3200
Practice Address - Country:US
Practice Address - Phone:863-875-6063
Practice Address - Fax:863-875-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty