TJ WELLNESS, LLC (NPI# 1275178188) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275178188 |
| Entity Type | Organization |
| Organization Name | TJ WELLNESS, LLC |
| Practice Address |
1893 Sw Kimberly Ave Port St Lucie FL 34953-1020 |
| Practice Telephone | 9544708268 |
| Mailing Telephone | 9544708268 |
| Enumeration Date | 2019-11-14 |
| Last Update Date | 2020-01-29 |
| Authorized Official Name | TAISHA JOHNSON (NURSE PRACTITIONER) |
| Authorized Official Telephone | 7726431645 |
| Authorized Official Credential | APRN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 208VP0000X |
Pain Medicine Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1893 SW KIMBERLY AVE |
| City | PORT ST LUCIE |
| State | FL |
| Zip Code | 34953-1020 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104381490 | Taisha Johnson | Nurse Practitioner | 1893 Sw Kimberly Ave, Port St Lucie, FL 34953-1020 | 2019-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033733720 | Paul Desantis | Optometrist | 1805 Gatlin Blvd, Port St. Lucie, FL 34953 | 2020-05-29 |
| 1174165997 | D&r Homehealthcare LLC | Technician | 1210 Southwest Santiago Avenue, Port Saint Lucie, Fl, FL 34953 | 2019-10-14 |
| 1023677630 | Physical Therapy Wellness Group | Clinic/Center | 519 Sw Nagle Place, Port Saint Lucie, FL 34953 | 2019-06-07 |
| 1063993699 | Bloom Firm, LLC | Home Health | 1714 Sw Cycle St, Port Saint Lucie, FL 34953 | 2018-08-22 |
| 1386121333 | For His Glory Alf LLC. | Assisted Living Facility | 322 Sw South Quick Circle, Port St Lucie, FL 34953 | 2018-07-23 |
| 1730670555 | Susan May Thyme | Nurse Practitioner | 1762 Sw Choate St, Port Saint Lucie, FL 34953 | 2018-05-29 |
| 1164911301 | Viven Banks | Counselor | 3581 Sw Kromrey St, Port Saint Lucie, FL 34953 | 2018-05-03 |
| 1205323441 | Katherine Monroig | Behavior Technician | 4557 Se Babylon St, Port Saint Lucie, FL 34953 | 2018-04-13 |
| 1528567583 | Roger Rene Trudel | Nurse Practitioner | 3686 Sw Carmody Street, Port St Lucie, FL 34953 | 2018-02-06 |
| 1801315502 | Metushela Nicolas | Adult Companion | 1112 Jennifer Ter, Port Saint Lucie, FL 34953 | 2017-09-13 |
| Find all providers in zip 34953 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407418361 | C.&s. Health Service | Nurse Practitioner | 4052 Sw Kadlic St, Port St Lucie, FL 34953-5672 | 2019-07-01 |
| 1336602382 | Bresha Patton Kantenga | Nurse Practitioner | 2318 Sw Wynnewood St, Port St Lucie, FL 34953-2439 | 2019-04-08 |
| 1043226814 | Elizabeth Ann Heilman | Nurse Practitioner | 2000 Se Port St Lucie Blvd, Port St Lucie, FL 34952-5546 | 2006-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649871724 | Brenna Schulman | Nurse Practitioner | 6859 Sw 18th St Ste 200, Boca Raton, FL 33433-7015 | 2020-11-04 |
| 1245831726 | Sydia Spence | Nurse Practitioner | 8001 Nw 66th Ter, Tamarac, FL 33321-7015 | 2020-11-02 |
| 1598365165 | Fernande Simeon | Nurse Practitioner | 6490 Nw 55th St, Coral Springs, FL 33067-2710 | 2020-10-31 |
| 1780284596 | Corrective Spinal Care Inc | Nurse Practitioner | 6965 Piazza Grande Ave Ste 207, Orlando, FL 32835-8780 | 2020-10-30 |
| 1023617420 | John Bertram Garrett Iv | Nurse Practitioner | 5079 Garrett Rd, Malone, FL 32445-3409 | 2020-10-19 |
| 1518565894 | Karen Giselle Reyes | Nurse Practitioner | 4563 Perth Rd, West Palm Beach, FL 33415-2811 | 2020-10-09 |
| 1265039424 | Catherine Dettelbach Lake | Nurse Practitioner | 3411 Shenandoah Dr W, Orange Park, FL 32073-6631 | 2020-10-01 |
| 1417562877 | Victoria Ann Jacobs | Nurse Practitioner | 3605 Lithia Ridge Blvd, Valrico, FL 33596-6482 | 2020-09-12 |
| 1760096135 | Conciergenp | Nurse Practitioner | 1221 S 23rd Ave, Hollywood, FL 33020-5912 | 2020-09-03 |
| 1649881434 | Dr Jose A Rivera LLC | Nurse Practitioner | 110 W Citrus St, Altamonte Springs, FL 32714-2502 | 2020-08-14 |
| Find all providers with the same taxonomy | ||||
| City | PORT ST LUCIE |
| Zip Code | 34953 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.