MEDICARE: GOLDEN OASIS HEALTHCARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1346841236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN OASIS HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	37734 BROWNS WAY
Second Line	:
City	:	MECHANICSVILLE
State	:	MD
Zip	:	20659-4630
Country	:	US
Telephone Number	:	336-259-2865
Fax Number	:

Provider Business Practice Location Address
First Line	:	37734 BROWNS WAY
Second Line	:
City	:	MECHANICSVILLE
State	:	MD
Zip	:	20659-4630
Country	:	US
Telephone Number	:	336-259-2865
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	FACHECIA FORT
Credential	:	DNP, CRNP
Telephone Number	:	336-259-2865

Provider Enumeration Date	:	11/05/2020
Last Update Date	:	11/02/2024

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