Healthcare Provider Details

I. General information

NPI: 1730920208
Provider Name (Legal Business Name): FLORIDA MEDICAL OFFICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1173 BLACKWOOD AVE
OCOEE FL
34761-4518
US

IV. Provider business mailing address

1121 BENNETT RD
ORLANDO FL
32814-6008
US

V. Phone/Fax

Practice location:
  • Phone: 407-925-7484
  • Fax: 321-340-3885
Mailing address:
  • Phone: 321-947-2170
  • Fax: 321-340-3885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. VIRGINIA M OLIVEIRA
Title or Position: AMBR
Credential: APRN
Phone: 321-947-2170