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General NPI Number Information
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NPI Number | 1952050957
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Entity Type | Organization
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Legal Business Name | ODESSA CAPITAL LLC
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Dates
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Enumeration Date | 03/18/2022
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 3633 LITTLE RD STE 103
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City | TRINITY
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State | FL
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Zip | 34655-1815
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Country | US
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Telephone | 352-293-2810
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Fax | 727-264-2117
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Provider Business Mailing Address
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Address Line | 3633 LITTLE RD STE 103
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City | TRINITY
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State | FL
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Zip | 34655-1815
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Country | US
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Telephone | 727-633-0003
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Fax | 727-334-8904
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | BRANDON WOMACK
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Credential |
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Telephone | 352-293-2810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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