Healthcare Provider Details

I. General information

NPI: 1487244083
Provider Name (Legal Business Name): ROWENA GAER MONTOJO-WEISS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 01/19/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 KELTON AVE
OCOEE FL
34761-3175
US

IV. Provider business mailing address

736 CANNA DR
DAVENPORT FL
33897-3828
US

V. Phone/Fax

Practice location:
  • Phone: 407-347-0571
  • Fax: 407-347-0520
Mailing address:
  • Phone: 407-219-8947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF12200110
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: