Organization · NPI-2

1977 Enterprise LLC

Nurse Practitioner · Orlando, FL

NPI number1952009995

StatusActive

Last updated in NPPESMar 8, 2024

Details

NPI: 1952009995
Entity type: Organization (NPI-2)
Legal business name: 1977 Enterprise LLC
Organization subpart: No
Enumeration date: Feb 20, 2023
Certification date: Mar 1, 2024
Last updated: Mar 8, 2024

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363L00000X	Nurse Practitioner	–	–	Yes
207QS0010X	Family Medicine, Sports Medicine	–	–
2084A0401X	Psychiatry & Neurology, Addiction Medicine	–	–
2084P0800X	Psychiatry & Neurology, Psychiatry	–	–
208M00000X	Hospitalist	–	–
363A00000X	Physician Assistant	–	–
363LA2200X	Nurse Practitioner, Adult Health	–	–
363LF0000X	Nurse Practitioner, Family	–	–
363LP0808X	Nurse Practitioner, Psych/Mental Health	–	–
363LP2300X	Nurse Practitioner, Primary Care	–	–

Other names

Take 2 Medical (Doing Business As)

Practice location

450 S Orange Ave Fl 3
Orlando, FL 32801-3394

Phone 407-212-7113 · Fax 407-264-8686

Mailing address

450 S Orange Ave Fl 3
Orlando, FL 32801-3394

Phone 407-212-7113 · Fax 407-264-8686

Authorized official

Marissa Early
Ceo
4072127113

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