Wellnessclinic on Wheels LLC
Organization Active NPI Psychiatric/Mental Health Nurse Practitioner · Deland, FL
NPI 1275425803 · NPPES record last updated Jul 17, 2025
Key facts
- NPI
- 1275425803
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- Legal business name
- WELLNESSCLINIC ON WHEELS LLC
- Practice address
- 470 S Spring Garden Ave
Deland, FL 32720-5080 - Phone
- (202) 834-7722
- NPI assigned
- Jul 17, 2025
- Organization subpart
- No
Authorized official
- Name
- El Agathe Asopo Tanyi
- Title
- Owner
- Phone
- (202) 834-7722
Corporate family (same tax ID) 1
Practitioners 2
-
El Agathe Asopo Tanyi, ARNP
-
Jacob K Agamasu, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20251125005050 | FL | Part B Supplier - Clinic/Group Practice | 1254823271 |
Receives reassigned benefits from 1 practitioner Practice locations: Deland, FL |
National Provider Directory
- Tax ID family
- Afterhours LLC
Locations
470 S Spring Garden Ave
Deland, FL 32720
Phone (202) 834-7722
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X | Yes |
Addresses
Primary practice location
470 S Spring Garden Ave
Deland, FL 32720-5080
Mailing address
1747 Fort Smith Blvd
Deltona, FL 32725-3728
Phone (202) 834-7722
Other providers in Deland, FL
- Iesha Wehrley
- Frederick Ethan Weiss
- Stephen G Weiss II
- Lisa Sproull Weithman
- Well-Watered Garden Massage and Wellness
- Gloria Louise Wert
- West Healthcare Inc
- West Volusia Family and Sports Medicine Inc
- West Volusia Medical Associates, P.a.
- West Volusia Pediatrics, PA
All providers in Deland, FL · Psychiatric/Mental Health Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.