Healthcare Provider Details

I. General information

NPI: 1053328799
Provider Name (Legal Business Name): ELIZABETH RYAN PALMER APRN, AP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 AMAZING WAY STE 211
OCOEE FL
34761-3491
US

IV. Provider business mailing address

404 MARY ELLEN CT
WINTER GARDEN FL
34787-2694
US

V. Phone/Fax

Practice location:
  • Phone: 407-654-6402
  • Fax:
Mailing address:
  • Phone: 407-621-1611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7064
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11043689
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3800
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: