Healthcare Provider Details

I. General information

NPI: 1134214380
Provider Name (Legal Business Name): EXODUS WOMEN'S CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 OAKFIELD DR
BRANDON FL
33511-5710
US

IV. Provider business mailing address

888 S PARSONS AVE
BRANDON FL
33511-6007
US

V. Phone/Fax

Practice location:
  • Phone: 813-684-2229
  • Fax:
Mailing address:
  • Phone: 813-684-2229
  • Fax: 813-654-1384

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: MS. LINDA S. MAYO
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 813-684-2229