MEDICARE: FLORIDA WOMAN CARE, 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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1487365128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA WOMAN CARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 9100
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-9100
Country	:	US
Telephone Number	:	561-626-3800
Fax Number	:	561-624-6364

Provider Business Practice Location Address
First Line	:	621 SE PORT ST LUCIE BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34984-5141
Country	:	US
Telephone Number	:	561-626-3800
Fax Number	:	561-624-6364

Authorized Official
Title or Position	:	MANAGER
Name	:	ERICA HERNANDEZ
Credential	:
Telephone Number	:	561-300-2410

Provider Enumeration Date	:	12/13/2022
Last Update Date	:	12/13/2022

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