Healthcare Provider Details

I. General information

NPI: 1174447817
Provider Name (Legal Business Name): ALYSSA MARIAH GILMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 W SR 434 STE 1500
LONGWOOD FL
32779-5003
US

IV. Provider business mailing address

7102 BROOKSIDE TRL
WINTER PARK FL
32792-7343
US

V. Phone/Fax

Practice location:
  • Phone: 407-862-3400
  • Fax:
Mailing address:
  • Phone: 321-263-9098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9122298
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: