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General NPI Number Information
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NPI Number | 1962074070
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Entity Type | Organization
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Legal Business Name | FWC UROGYNECOLOGY, LLC
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Dates
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Enumeration Date | 07/16/2021
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Last Update Date | 07/07/2022
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Provider Practice Location Address
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Address Line | 6885 BELFORT OAKS PL STE 110
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6281
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Country | US
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Telephone | 904-652-0373
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Fax | 904-652-0378
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Provider Business Mailing Address
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Address Line | PO BOX 5556
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City | BELFAST
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State | ME
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Zip | 04915-5500
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Country | US
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Telephone | 561-300-2410
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Fax | 561-235-7292
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Authorized Official
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Title or Position | MANAGER
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Name | ERICA HERNANDEZ
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Credential |
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Telephone | 561-300-2410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2088F0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
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License Number |
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License Number State |
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