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	:	1497321939
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	:	8145 CEREBELLUM WAY STE 101&102
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-1788
Country	:	US
Telephone Number	:	727-845-4999
Fax Number	:	866-777-2195

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

Provider Enumeration Date	:	06/03/2021
Last Update Date	:	06/20/2022

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