Healthcare Provider Details

I. General information

NPI: 1629446810
Provider Name (Legal Business Name): PWT NURSE CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 09/04/2015
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 STE 107
OCOEE FL
34761-7014
US

V. Phone/Fax

Practice location:
  • Phone: 407-925-7237
  • Fax: 407-445-4601
Mailing address:
  • Phone: 407-925-7237
  • Fax: 407-445-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number
License Number StateFL

VIII. Authorized Official

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