Healthcare Provider Details

I. General information

NPI: 1275324105
Provider Name (Legal Business Name): OSEREMEN AIWORIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 JOHN SIMS PKWY E
NICEVILLE FL
32578-2712
US

IV. Provider business mailing address

509 NELSON POINT RD
NICEVILLE FL
32578-4518
US

V. Phone/Fax

Practice location:
  • Phone: 850-389-8489
  • Fax: 844-377-9201
Mailing address:
  • Phone: 407-221-7708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11039411
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: