| Organization Name: | TARGET WELLNESS LLC |
| NPI Number: | 1114321833 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHELE R ELLERT (OWNER) |
| Mailing Address: | 713 Park Valley Cir Minneola |
| State: | FL US |
| Postal Code: | 347157952 |
| Phone Number: | 4074737545 |
| Fax Number: | 3525362087 |
| NPI Enumeration Date: | 10/09/2014 |
| NPI Last Update Date: | 10/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | ARNP 2166292 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |