Healthcare Provider Details

I. General information

NPI: 1093079865
Provider Name (Legal Business Name): AYANNA D. WALKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W. OAK ST
KISSIMMEE FL
34741
US

IV. Provider business mailing address

7700 W. SUNRISE BLVD
PLANTATION FL
33322
US

V. Phone/Fax

Practice location:
  • Phone: 407-518-3553
  • Fax: 407-518-3636
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN17592
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME121053
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: