Provider Demographics
NPI:1871360438
Name:METANOIA WELLNESS CARE LLC
Entity type:Organization
Organization Name:METANOIA WELLNESS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:R
Authorized Official - Last Name:CABALLERO RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN FNP-BC
Authorized Official - Phone:787-218-6456
Mailing Address - Street 1:1404 TROPICAL OASIS AVE
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33565-5963
Mailing Address - Country:US
Mailing Address - Phone:787-218-6456
Mailing Address - Fax:
Practice Address - Street 1:1404 TROPICAL OASIS AVE
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33565-5963
Practice Address - Country:US
Practice Address - Phone:787-218-6456
Practice Address - Fax:813-867-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty