Provider Demographics
NPI:1275324105
Name:AIWORIA, OSEREMEN
Entity type:Individual
Prefix:
First Name:OSEREMEN
Middle Name:
Last Name:AIWORIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MEADOW WOODS LN
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3938
Mailing Address - Country:US
Mailing Address - Phone:407-221-7708
Mailing Address - Fax:
Practice Address - Street 1:331 N MAITLAND AVE STE C3
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4754
Practice Address - Country:US
Practice Address - Phone:407-634-3515
Practice Address - Fax:920-696-8797
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11039411363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health