The Tower Ridge Group LLC
Nurse Practitioner, Family in Lake Wales, FL. Organization (NPI-2).
NPI number1093519829
StatusActive
Last updated in NPPESApr 2, 2025
Details
- NPI
- 1093519829
- Entity type
- Organization (NPI-2)
- Legal business name
- The Tower Ridge Group LLC
- Organization subpart
- No
- Enumeration date
- Apr 2, 2025
- Certification date
- Apr 2, 2025
- Last updated
- Apr 2, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | – | – | Yes |
Practice location
158 S Lake Starr BlvdLake Wales, FL 33898-7661
Phone 863-855-0047 · Fax 888-504-1691
Mailing address
23781 Us Highway 27 # 139Lake Wales, FL 33859-7802
Phone 863-855-0047 · Fax 888-504-1691
Authorized official
Donald Johnson
Owner
8638550047
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