Provider Demographics
NPI:1447019526
Name:ARCHER HEALTH AND WELLNESS, LLC
Entity type:Organization
Organization Name:ARCHER HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANIQUEA
Authorized Official - Middle Name:NAYOUKA A
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:305-333-7784
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-0081
Mailing Address - Country:US
Mailing Address - Phone:561-660-5749
Mailing Address - Fax:
Practice Address - Street 1:7070 SEMINOLE PRATT WHITNEY RD STE 5
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-3491
Practice Address - Country:US
Practice Address - Phone:561-660-5749
Practice Address - Fax:561-660-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty