Healthcare Provider Details

I. General information

NPI: 1124580451
Provider Name (Legal Business Name): TANIA MOWATT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 04/21/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 OCOEE APOPKA RD
OCOEE FL
34761-5301
US

IV. Provider business mailing address

32845 RADIO RD
LEESBURG FL
34788-3977
US

V. Phone/Fax

Practice location:
  • Phone: 407-756-5393
  • Fax:
Mailing address:
  • Phone: 352-504-3453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9218188
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: