NPI 1952009995 · live from the CMS NPI Registry
1977 Enterprise LLC
Nurse Practitioner in Orlando, FL. National Provider Identifier 1952009995, active.
NPI record
| NPI | 1952009995 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner 363L00000X |
| Practice location | 450 S Orange Ave Fl 3, Orlando, FL 32801 |
| Practice phone | 407-212-7113 |
| Enumerated | February 20, 2023 |
| Last updated | March 8, 2024 |
| Authorized official | Marissa Early, Ceo |
| Other names | Take 2 Medical |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine, Sports Medicine | 207QS0010X | — |
| Psychiatry & Neurology, Addiction Medicine | 2084A0401X | — |
| Psychiatry & Neurology, Psychiatry | 2084P0800X | — |
| Hospitalist | 208M00000X | — |
| Physician Assistant | 363A00000X | — |
| Nurse Practitioner primary | 363L00000X | — |
| Nurse Practitioner, Adult Health | 363LA2200X | — |
| Nurse Practitioner, Family | 363LF0000X | — |
| Nurse Practitioner, Psych/Mental Health | 363LP0808X | — |
| Nurse Practitioner, Primary Care | 363LP2300X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.