Healthcare Provider Details

I. General information

NPI: 1366597288
Provider Name (Legal Business Name): CHRISTINE DWYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SE 17TH ST STE 101 BLDG 100
OCALA FL
34471-4152
US

IV. Provider business mailing address

4520 SW 106TH PL
OCALA FL
34476-4212
US

V. Phone/Fax

Practice location:
  • Phone: 352-861-0272
  • Fax: 352-861-0117
Mailing address:
  • Phone: 352-873-0823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN 3058392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: