Healthcare Provider Details

I. General information

NPI: 1891581906
Provider Name (Legal Business Name): FLORIDA WOMAN CARE ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 SAN MARCO AVE
ST AUGUSTINE FL
32084-2729
US

IV. Provider business mailing address

PO BOX 81798
CLEVELAND OH
44181-0798
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-1500
  • Fax: 904-810-1023
Mailing address:
  • Phone: 561-300-2410
  • Fax:

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: TAMMY WALKER
Title or Position: ENROLLMENT
Credential:
Phone: 561-300-2410