Provider Demographics
NPI:1629446810
Name:PWT NURSE CONSULTANTS LLC
Entity Type:Organization
Organization Name:PWT NURSE CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-925-7237
Mailing Address - Street 1:1746 E SILVER STAR RD STE 107
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-7014
Mailing Address - Country:US
Mailing Address - Phone:407-925-7237
Mailing Address - Fax:407-445-4601
Practice Address - Street 1:7034 MINIPPI DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3345
Practice Address - Country:US
Practice Address - Phone:407-925-7237
Practice Address - Fax:407-445-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL163WA2000X, 163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontologyGroup - Single Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty