Healthcare Provider Details

I. General information

NPI: 1255876827
Provider Name (Legal Business Name): PAIGE M CUPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAIGE MACKENZIE

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR STE 495
OCOEE FL
34761
US

IV. Provider business mailing address

10000 W COLONIAL DR STE 495
OCOEE FL
34761-3436
US

V. Phone/Fax

Practice location:
  • Phone: 407-293-5944
  • Fax:
Mailing address:
  • Phone: 407-293-5944
  • Fax: 407-293-7355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 9109979
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: