Healthcare Provider Details

I. General information

NPI: 1316244502
Provider Name (Legal Business Name): FLORIDA WOMAN CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 MIZELL AVE SUITE 206
WINTER PARK FL
32792-4155
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: 407-645-3055
  • Fax: 407-647-5125
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: DR. KENNETH KONSKER
Title or Position: PRESIDENT
Credential: MD
Phone: 561-300-2410