1977 Enterprise LLC

NPI #1952009995 in Orlando, Florida

Provider Information

NPI Number: 1952009995
Entity Type: Organization
Organization Name: 1977 Enterprise LLC
Primary Specialty: Nurse Practitioner
Enumeration Date: Feb 20, 2023
Last Updated: Mar 8, 2024

Practice Location

Address: 450 S ORANGE AVE FL 3
City: Orlando
State: Florida
ZIP Code: 32801-3394
Phone: (407) 212-7113

Authorized Official

Name: MARISSA EARLY
Title: CEO
Phone: (407) 212-7113

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine - Sports Medicine — Sports Medicine	207QS0010X
Psychiatry & Neurology - Addiction Medicine — Addiction Medicine	2084A0401X
Psychiatry & Neurology - Psychiatry — Psychiatry	2084P0800X
Hospitalist	208M00000X
Physician Assistant	363A00000X
Nurse Practitioner - Adult Health — Adult Health	363LA2200X
Nurse Practitioner - Family — Family	363LF0000X
Nurse Practitioner - Psychiatric/Mental Health — Psychiatric/Mental Health	363LP0808X
Nurse Practitioner - Primary Care — Primary Care	363LP2300X
Nurse Practitioner	363L00000X	Primary

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