Healthcare Provider Details

I. General information

NPI: 1578059739
Provider Name (Legal Business Name): PWT NURSE CONSULTANTS & HOME SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7034 MINIPPI DR
ORLANDO FL
32818-3345
US

IV. Provider business mailing address

1746 E SILVER STAR RD # 107
OCOEE FL
34761-7014
US

V. Phone/Fax

Practice location:
  • Phone: 407-925-7237
  • Fax:
Mailing address:
  • Phone: 407-925-7237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2529832
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number0700506
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number235270
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number235270
License Number StateFL

VIII. Authorized Official

Name: PHYLLIS TYSON
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 407-925-7237