Healthcare Provider Details

I. General information

NPI: 1609949783
Provider Name (Legal Business Name): MRS. MARGRETTE PEMBERTON ACKERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MICHIGAN ST
ORLANDO FL
32805-6203
US

IV. Provider business mailing address

1759 SUNSET DR
WINTER PARK FL
32789-1652
US

V. Phone/Fax

Practice location:
  • Phone: 407-317-7430
  • Fax:
Mailing address:
  • Phone: 407-579-8117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS 0000377
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: