Healthcare Provider Details

I. General information

NPI: 1750838041
Provider Name (Legal Business Name): NORTHWEST FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5844 N ORANGE BLOSSOM TRL
ORLANDO FL
32810-1025
US

IV. Provider business mailing address

PO BOX 951306
LAKE MARY FL
32795-1306
US

V. Phone/Fax

Practice location:
  • Phone: 407-602-1100
  • Fax: 407-219-4221
Mailing address:
  • Phone: 407-602-1100
  • Fax: 407-219-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN675
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2279E0002X
TaxonomyEmergency Care Registered Respiratory Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME128359
License Number StateFL

VIII. Authorized Official

Name: DR. GARRY B ANTOINE
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 407-768-5773