Healthcare Provider Details

I. General information

NPI: 1245476142
Provider Name (Legal Business Name): WOMENS CARE FLORIDA LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 KINGS LAKE DRIVE #102
GIBSONTON FL
33534
US

IV. Provider business mailing address

PO BOX 748817
ATLANTA GA
30374-8817
US

V. Phone/Fax

Practice location:
  • Phone: 813-574-1350
  • Fax: 813-574-1360
Mailing address:
  • Phone: 813-286-0033
  • Fax: 813-282-1806

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: ELLEN MICHELLE BOWER
Title or Position: COO
Credential:
Phone: 813-286-2033