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