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Specialty details in registry · Orlando, FL

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At a glance

12195 S Orange Blossom Trl, Orlando, FL 32837-6502

NPPES record updated Apr 17, 2015. Public records can lag behind changes at a practice.

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Insurance participation and appointment availability are not established by these public records.

Practice location

12195 S Orange Blossom Trl
Orlando, FL 32837-6502

Professional details: NPI, taxonomy & registry record

NPI1730576745

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 3336C0003X
Enumeration date: Apr 17, 2015
Record updated: Apr 17, 2015

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

3336C0003X · Primary

License reported: PS43863 FL

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

12195 S Orange Blossom Trl
Orlando, FL 32837-6502

Phone: (407) 816-4233

Mailing address

12195 S ORANGE BLOSSOM TRL

ORLANDO, FL 328376502

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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