Healthcare Provider Details

I. General information

NPI: 1841109808
Provider Name (Legal Business Name): FLORIDA HOSPITAL WATERMAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 COUNTY RD 466A
FRUITLAND PARK FL
34731-5153
US

IV. Provider business mailing address

770 W GRANADA BLVD STE 203
ORMOND BEACH FL
32174-5179
US

V. Phone/Fax

Practice location:
  • Phone: 352-508-4235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: ANDRII KORCHUK
Title or Position: CFO
Credential:
Phone: 352-253-3300