Provider

1977 ENTERPRISE LLC

Public NPPES listing with taxonomy: Nurse Practitioner.

Resource details

Medicare status: Confirm directly

Unknown from NPPES

Source: NPPES NPI Registry

NPI: 1952009995

Taxonomy: Nurse Practitioner (363L00000X)

Source confidence: 58%

Medicare assignment: Unknown from NPPES

Address: 450 S ORANGE AVE FL 3, ORLANDO, FL, 328013394

Phone: 407-212-7113

Last verified: May 18, 2026