MEDICARE: WOMEN'S CARE FLORIDA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114500030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMEN'S CARE FLORIDA LLC

Provider Business Mailing Address
First Line	:	PO BOX 748817
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8817
Country	:	US
Telephone Number	:	813-286-0033
Fax Number	:

Provider Business Practice Location Address
First Line	:	1232 KING STREET
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204
Country	:	US
Telephone Number	:	48-217-5569
Fax Number	:	855-707-1416

Authorized Official
Title or Position	:	COO
Name	:	ELLEN MICHELLE BOWER
Credential	:
Telephone Number	:	813-286-2033

Provider Enumeration Date	:	04/29/2021
Last Update Date	:	11/24/2023

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Directions to “WOMEN'S CARE FLORIDA LLC ” Practice Location

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