Healthcare Provider Details

I. General information

NPI: 1477136398
Provider Name (Legal Business Name): WOMEN'S CARE FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 13TH AVE S STE 190
JACKSONVILLE BEACH FL
32250-3235
US

IV. Provider business mailing address

PO BOX 25317
TAMPA FL
33622-5317
US

V. Phone/Fax

Practice location:
  • Phone: 904-247-5514
  • Fax: 904-247-3363
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 2
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