Healthcare Provider Details
I. General information
NPI: 1013587732
Provider Name (Legal Business Name): FLORIDA WOMAN CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/25/2021
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1815 S KANNER HWY
STUART FL
34994-7204
US
IV. Provider business mailing address
PO BOX 9100
BELFAST ME
04915-9100
US
V. Phone/Fax
- Phone: 772-288-2992
- Fax: 772-288-2999
- Phone: 561-300-2410
- Fax: 561-235-7292
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207VG0400X |
| Taxonomy | Gynecology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
AARON
MATTHEW
SUDBURY
Title or Position: PRESIDENT
Credential:
Phone: 941-745-5115