J.C. Wellness & Primary Care, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

J.C. WELLNESS & PRIMARY CARE, LLC

Practice address

616 E Altamonte Dr Ste 203
Altamonte Springs, FL 32701-4810

Phone

(407) 701-7356

Fax

(407) 598-8830

NPI assigned

Apr 18, 2023

Organization subpart

No

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

Authorized official

Name

Kenisha T. Wood, APRN

Title

Nurse Practitioner/ Owner

Phone

(631) 219-8520

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1346937737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3718 GREYTHORNE LOOP",
            "city": "OVIEDO",
            "state": "FL",
            "postal_code": "327659054",
            "telephone_number": "407-701-7356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 E ALTAMONTE DR STE 203",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327014810",
            "telephone_number": "407-701-7356",
            "fax_number": "407-598-8830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J.C. WELLNESS & PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-18",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "KENISHA",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "NURSE PRACTITIONER/ OWNER",
        "authorized_official_telephone_number": "631-219-8520",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Altamonte Springs, FL
• Providers in Altamonte Springs, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.