Healthcare Provider Details

I. General information

NPI: 1164098984
Provider Name (Legal Business Name): FLORIDA WOMAN CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 NE 138TH LN BLDG 400
LADY LAKE FL
32159-6831
US

IV. Provider business mailing address

PO BOX 9100
BELFAST ME
04915-9100
US

V. Phone/Fax

Practice location:
  • Phone: 352-690-6300
  • Fax: 352-690-6802
Mailing address:
  • Phone: 561-300-2410
  • Fax: 561-235-7292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ERICA HERNANDEZ
Title or Position: MANAGER
Credential:
Phone: 561-300-2410