Provider Demographics
NPI:1619848892
Name:DYNAMIC WELLNESS NP LLC
Entity type:Organization
Organization Name:DYNAMIC WELLNESS NP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:CLOW
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:352-204-8904
Mailing Address - Street 1:8245 COUNTY ROAD 44 LEG A STE 1
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3751
Mailing Address - Country:US
Mailing Address - Phone:352-204-8904
Mailing Address - Fax:949-703-7406
Practice Address - Street 1:8245 COUNTY ROAD 44 LEG A STE 1
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3751
Practice Address - Country:US
Practice Address - Phone:352-204-8904
Practice Address - Fax:949-703-7406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty