Healthcare Provider Details

I. General information

NPI: 1841841830
Provider Name (Legal Business Name): ALLIANCE OBSTETRICS AND GYNECOLOGY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 GLENWOOD DR
WINTER PARK FL
32792-3307
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 407-960-2112
  • Fax: 407-960-7024
Mailing address:
  • Phone: 407-960-2112
  • Fax: 407-960-7024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMEIGH VERDEROSA WORLEY
Title or Position: OWNER/PHYSICIAN
Credential:
Phone: 321-794-1864