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NPI Code Detail

MEDICARE: ERIN WISEMAN WHITE PA

MEDICARE: ERIN WISEMAN WHITE PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA9104307FL

General Provider Information

NPI Number : 1356535074
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN WISEMAN WHITE PA
Provider Business Mailing Address
First Line : 100 ALEXANDRIA BLVD
Second Line : SUITE 1
City : OVIEDO
State : FL
Zip : 32765-8298
Country : US
Telephone Number : 407-359-7997
Fax Number : 407-359-6662
Provider Business Practice Location Address
First Line : 100 ALEXANDRIA BLVD
Second Line : SUITE 1
City : OVIEDO
State : FL
Zip : 32765-8298
Country : US
Telephone Number : 407-359-7997
Fax Number : 407-359-6662
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2007
Last Update Date : 02/25/2008

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Directions to “ ERIN WISEMAN WHITE PA” Practice Location

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