Healthcare Provider Details

I. General information

NPI: 1255177192
Provider Name (Legal Business Name): FLORIDA WOMAN CARE ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 W PALMETTO PARK RD STE 103C
BOCA RATON FL
33433-3455
US

IV. Provider business mailing address

PO BOX 9100
BELFAST ME
04915-9100
US

V. Phone/Fax

Practice location:
  • Phone: 561-425-9251
  • Fax: 561-392-7509
Mailing address:
  • Phone: 561-300-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY S WALKER
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 561-300-2410