Provider Demographics
NPI:1881332740
Name:BENEFICENT MIND & BODY
Entity type:Organization
Organization Name:BENEFICENT MIND & BODY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WACKER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:424-262-2627
Mailing Address - Street 1:2497 SW 27TH AVE # 1045
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:390 N ORANGE AVE STE 2300-N
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1640
Practice Address - Country:US
Practice Address - Phone:424-262-2627
Practice Address - Fax:779-204-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-21
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center