Healthcare Provider Details

I. General information

NPI: 1205396611
Provider Name (Legal Business Name): MOUNT OF MERCY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11268 S APOPKA VINELAND RD
ORLANDO FL
32836-6152
US

IV. Provider business mailing address

7136 ALTIS WAY # 2102
ORLANDO FL
32836-6870
US

V. Phone/Fax

Practice location:
  • Phone: 407-465-1993
  • Fax: 888-565-9271
Mailing address:
  • Phone: 321-396-2877
  • Fax: 888-565-9271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HAROON R NAWAZ
Title or Position: OWNER
Credential:
Phone: 321-396-2877