Healthcare Provider Details

I. General information

NPI: 1679775480
Provider Name (Legal Business Name): ORANGE COUNTY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3723 VISION BLVD
ORLANDO FL
32839
US

IV. Provider business mailing address

1718 FAWN COVE LN
APOPKA FL
32703-1638
US

V. Phone/Fax

Practice location:
  • Phone: 407-254-8330
  • Fax:
Mailing address:
  • Phone: 407-889-4970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number2524132
License Number StateFL

VIII. Authorized Official

Name: MRS. JOAN ANNETTA SHAKESPEARE-RAMSAY
Title or Position: RN
Credential: RN
Phone: 407-254-8330