MEDICARE: MR. JEREMY PAUL EWBANK 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
1	363A00000X	Physician Assistant	PA9104927	FL
2	363AS0400X	Surgical Physician Assistant	PA9104927	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760620314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEREMY PAUL EWBANK PA

Provider Business Mailing Address
First Line	:	601 E ROLLINS ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-1248
Country	:	US
Telephone Number	:	407-609-0095
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 E ROLLINS ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-1248
Country	:	US
Telephone Number	:	407-609-0095
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2009
Last Update Date	:	04/09/2026

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