Healthcare Provider Details

I. General information

NPI: 1871108589
Provider Name (Legal Business Name): NORDICA D OWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 W LUMSDEN RD
BRANDON FL
33511-5911
US

IV. Provider business mailing address

621 W LUMSDEN RD
BRANDON FL
33511-5911
US

V. Phone/Fax

Practice location:
  • Phone: 137-553-5008
  • Fax: 813-755-3300
Mailing address:
  • Phone: 137-553-5008
  • Fax: 813-755-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11007896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: