MEDICARE: FLORIDA WOMAN CARE 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	:	1154998623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA WOMAN CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 9100
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-9100
Country	:	US
Telephone Number	:	561-300-2410
Fax Number	:	561-235-7292

Provider Business Practice Location Address
First Line	:	8400 RED BUG LAKE RD STE 2010
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-6838
Country	:	US
Telephone Number	:	321-304-6249
Fax Number	:	321-304-6004

Authorized Official
Title or Position	:	MANAGER
Name	:	ERICA HERNANDEZ
Credential	:
Telephone Number	:	561-300-2410

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	02/24/2022

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