MEDICARE: NUTMEG HOLDINGS 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1619132867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTMEG HOLDINGS LLC

Provider Business Mailing Address
First Line	:	PO BOX 149374
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-9374
Country	:	US
Telephone Number	:	407-893-3905
Fax Number	:	407-893-3906

Provider Business Practice Location Address
First Line	:	1459 LAKE BALDWIN LN
Second Line	:	SUITE A
City	:	ORLANDO
State	:	FL
Zip	:	32814-6741
Country	:	US
Telephone Number	:	407-893-3905
Fax Number	:	407-893-3906

Authorized Official
Title or Position	:	MANAGER / DIRECTOR
Name	:	S RAFIK BOUAZIZ
Credential	:
Telephone Number	:	407-893-3905

Provider Enumeration Date	:	07/26/2008
Last Update Date	:	03/09/2012

Similar Medicare Providers

1467435768 — ALI SHAYGAN MD
Practice Location Address:

1459 LAKE BALDWIN LN , SUITE A
ORLANDO, FL
32814-6741

Practice Phone: 407-893-3905
Practice Fax:

1306079710 — DERASH INC
Practice Location Address:

1459 LAKE BALDWIN LN , SUITE A
ORLANDO, FL
32814-6741

Practice Phone: 407-893-3905
Practice Fax: 407-893-3906

1922576610 — MARLENA JOY MILES LCSW
Practice Location Address:

531 SUNGLOW DR
ORLANDO, FL
32803-6741

Practice Phone: 407-579-7167
Practice Fax:

1700744240 — ROXANA SOCORRO
Practice Location Address:

907 OUTER RD STE B
ORLANDO, FL
32814-6601

Practice Phone: 407-217-1401
Practice Fax:

1235091836 — WYATT JOEL SHEALY
Practice Location Address:

907 OUTER RD STE B
ORLANDO, FL
32814-6601

Practice Phone: 855-832-6727
Practice Fax:

1134837289 — LISA MARIE TREVINO
Practice Location Address:

907 OUTER RD STE B
ORLANDO, FL
32814-6601

Practice Phone: 512-596-4883
Practice Fax:

Directions to “NUTMEG HOLDINGS LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.