Healthcare Provider Details

I. General information

NPI: 1487056842
Provider Name (Legal Business Name): EMILY ELLIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY PADGETT PA-C

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2528
  • Fax: 407-303-2760
Mailing address:
  • Phone: 813-821-8038
  • Fax: 813-974-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberND6061
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14548
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9112117
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: