Healthcare Provider Details

I. General information

NPI: 1134847940
Provider Name (Legal Business Name): EMILY OSWALD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N CLYDE MORRIS BLVD STE 500
DAYTONA BEACH FL
32114-2768
US

IV. Provider business mailing address

PO BOX 100138
GAINESVILLE FL
32610-0138
US

V. Phone/Fax

Practice location:
  • Phone: 386-425-2639
  • Fax:
Mailing address:
  • Phone: 352-273-8670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberAPRN11012498
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11012498
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: