Healthcare Provider Details

I. General information

NPI: 1578852430
Provider Name (Legal Business Name): FLORIDA WOMAN CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 ALT 19
PALM HARBOR FL
34683-1926
US

IV. Provider business mailing address

4205 W ATLANTIC AVE SUITE C-304
DELRAY BEACH FL
33445-3901
US

V. Phone/Fax

Practice location:
  • Phone: 727-789-9006
  • Fax: 727-789-9122
Mailing address:
  • Phone: 561-300-2410
  • Fax: 561-495-5408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH A KONSKER
Title or Position: PRESIDENT
Credential: MD
Phone: 561-300-2410