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Organization
1977 ENTERPRISE LLC
Active
Organization
1977 ENTERPRISE LLC
Active
Other names
Take 2 Medical
Organization subpart
No
Provider details
NPI number
Authorized official
MARISSA EARLY (CEO)
(407) 212-7113
Entity
Organization
Contact information
Practice address
450 S ORANGE AVE FL 3, ORLANDO, FL 32801-3394
(407) 212-7113
(407) 264-8686
Mailing address
450 S ORANGE AVE FL 3, ORLANDO, FL 32801-3394
(407) 212-7113
(407) 264-8686
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208M00000X
Hospitalist Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
Primary
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
02/20/2023
Last updated
03/08/2024
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