Healthcare Provider Details

I. General information

NPI: 1760108617
Provider Name (Legal Business Name): ROLANDO PADRON WONG APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 N JOHN YOUNG PKWY
KISSIMMEE FL
34741-4914
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 407-956-1920
  • Fax: 407-271-8436
Mailing address:
  • Phone: 321-332-6947
  • Fax: 407-286-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11022376
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: