1977 Enterprise LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

1977 ENTERPRISE LLC

Doing business as

Take 2 Medical

Practice address

450 S Orange Ave FL 3
Orlando, FL 32801-3394

Phone

(407) 212-7113

Fax

(407) 264-8686

NPI assigned

Feb 20, 2023

Last updated

Mar 8, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marissa Early

Title

Ceo

Phone

(407) 212-7113

Specialties & licenses 10

Addresses

Other names 1

• Take 2 Medical Doing business as

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Danielle Trenelli, NP

  • Nurse Practitioner
  • Orlando, FL
  • NPI 1558803676
  NPD (past)
• Tangular Barnes

  • Psychiatric/Mental Health Nurse Practitioner
  • Gulfport, MS
  • NPI 1902294093

  Family

  NPD (past)
• Valmy Nkienyack Fotendong

  • Psychiatric/Mental Health Nurse Practitioner
  • Washington, DC
  • NPI 1730543281
  NPD (past)
• Sunil Kurup, M.D.

  • Sports Medicine (Family Medicine) Physician
  • Dallas, TX
  • NPI 1952532988
  NPD (past)
• Patty-Jo Katherine Mantel, DNP

  • Family Nurse Practitioner
  • Roseville, MN
  • NPI 1508376732
  NPD (past)
• Abhishek Patel, D.O.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Austin, TX
  • NPI 1780944918
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709856000000",
    "number": "1952009995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 S ORANGE AVE FL 3",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328013394",
            "telephone_number": "407-212-7113",
            "fax_number": "407-264-8686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 S ORANGE AVE FL 3",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328013394",
            "telephone_number": "407-212-7113",
            "fax_number": "407-264-8686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1977 ENTERPRISE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-20",
        "last_updated": "2024-03-08",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "EARLY",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "407-212-7113"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Take 2 Medical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Take 2 Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Nurse Practitioner in Orlando, FL
• Providers in Orlando, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.