MEDICARE: FLORIDA MEDICAL OFFICE 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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1730920208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA MEDICAL OFFICE LLC

Provider Business Mailing Address
First Line	:	1121 BENNETT RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6008
Country	:	US
Telephone Number	:	321-947-2170
Fax Number	:	321-340-3885

Provider Business Practice Location Address
First Line	:	1173 BLACKWOOD AVE
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-4518
Country	:	US
Telephone Number	:	407-925-7484
Fax Number	:	321-340-3885

Authorized Official
Title or Position	:	AMBR
Name	:	MRS. VIRGINIA M OLIVEIRA
Credential	:	APRN
Telephone Number	:	321-947-2170

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	05/28/2026

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