MEDICARE: FLORENCE WOBERAERE EJIOWHOR RN, ADMINISTRATOR

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	163W00000X	Registered Nurse	RN3421032	FL

General Provider Information

NPI Number	:	1396255139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FLORENCE WOBERAERE EJIOWHOR RN, ADMINISTRATOR

Provider Business Mailing Address
First Line	:	753 NIGHT OWL CT
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-5139
Country	:	US
Telephone Number	:	407-497-1243
Fax Number	:	407-696-0387

Provider Business Practice Location Address
First Line	:	2119 BEACON LANDING CIR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-4374
Country	:	US
Telephone Number	:	407-497-1243
Fax Number	:	407-696-0387

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2017
Last Update Date	:	10/06/2017

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