Fountain Life Orlando, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

FOUNTAIN LIFE ORLANDO, LLC

Practice address

6424 Alexandra Louise Dr Ste 120
Orlando, FL 32827-5812

Phone

(917) 810-8672

NPI assigned

Jul 21, 2023

Organization subpart

No

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

Authorized official

Name

Mrs. Barbara Woo

Title

Director of Clinical Operations

Phone

(407) 725-1516

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1689897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689897600000",
    "number": "1699455956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6424 ALEXANDRA LOUISE DR STE 120",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328275812",
            "telephone_number": "917-810-8672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6424 ALEXANDRA LOUISE DR STE 120",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328275812",
            "telephone_number": "917-810-8672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN LIFE ORLANDO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-21",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A",
        "authorized_official_last_name": "WOO",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL OPERATIONS",
        "authorized_official_telephone_number": "407-725-1516",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Maria Foti
• Pierre Fotso, M.D.
• Kris Fought, PT 15372
• Miranda Fouladi, CCC-SLP
• Brittnee K Foulke, DNP, APRN, FNP-C
• Courtney Fountain, RBT
• Jacorey Fountain
• Four Season Dental LLC
• Keith Fournet, MD
• Kevin Fournet, MD

• Clinic/Center in Orlando, FL
• Providers in Orlando, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.