# 1977 ENTERPRISE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Take 2 Medical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952009995
- **Authorized official:** MARISSA EARLY (CEO)
- **Authorized official phone:** (407) 212-7113

## Contact information

- **Practice address:** 450 S ORANGE AVE FL 3, ORLANDO, FL 32801-3394
- **Practice address phone:** (407) 212-7113
- **Practice address fax:** (407) 264-8686
- **Mailing address:** 450 S ORANGE AVE FL 3, ORLANDO, FL 32801-3394
- **Mailing address phone:** (407) 212-7113
- **Mailing address fax:** (407) 264-8686

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | — |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | — | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 208M00000X | Hospitalist Physician | — | — | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 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