Southbrdge Health and Wellness LLC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

Legal business name

SOUTHBRDGE HEALTH AND WELLNESS LLC

Practice address

476 Riverside Ave # 1905
Jacksonville, FL 32202-4912

Phone

(904) 800-9220

Fax

(904) 674-1843

NPI assigned

Dec 20, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dora Agyei Agyemang, MSN, APRN, ANP-BCNPI 1578792693

Title

Owner

Phone

(912) 800-9220

Specialties & licenses 6

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dora A. Agyemang, MSN, ANP-BC

  • Adult Health Nurse Practitioner
  • Savannah, GA
  • NPI 1578792693

  Adult Health

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1703030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703030400000",
    "number": "1043089998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "851 SOUTHBRIDGE BLVD",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314051096",
            "telephone_number": "912-657-5256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "476 RIVERSIDE AVE # 1905",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322024912",
            "telephone_number": "904-800-9220",
            "fax_number": "904-674-1843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHBRDGE HEALTH AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-20",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-19",
        "status": "A",
        "authorized_official_last_name": "AGYEMANG",
        "authorized_official_first_name": "DORA",
        "authorized_official_middle_name": "AGYEI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-800-9220",
        "authorized_official_credential": "MSN, APRN, ANP-BC"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Jacksonville, FL
• Adult Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.