# LARGO WELLNESS PRIMARY CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245759596
- **Authorized official:** MICKORIA SMITH (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (561) 420-7501

## Contact information

- **Practice address:** 415 7TH AVE SW, LARGO, FL 33770-3400
- **Practice address phone:** (727) 501-1040
- **Mailing address:** 415 7TH AVE SW, LARGO, FL 33770-3400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/18/2017
- **Last updated:** 09/26/2018