Provider Demographics
NPI:1811613441
Name:MDNP WELLNESS PARTNERS
Entity type:Organization
Organization Name:MDNP WELLNESS PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:JARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-918-1799
Mailing Address - Street 1:5 WINDWARD LN
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-5081
Mailing Address - Country:US
Mailing Address - Phone:954-918-1799
Mailing Address - Fax:
Practice Address - Street 1:5 WINDWARD LN
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-5081
Practice Address - Country:US
Practice Address - Phone:954-918-1799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MDNP HEALTHCARE PARTNERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEUGWIOtherBCBS PROVIDER