Healthcare Provider Details

I. General information

NPI: 1316353667
Provider Name (Legal Business Name): PATRICIA LOUISE AMBROSIO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 S JOHN YOUNG PKWY
ORLANDO FL
32839-3716
US

IV. Provider business mailing address

5900 S JOHN YOUNG PKWY
ORLANDO FL
32839-3716
US

V. Phone/Fax

Practice location:
  • Phone: 407-398-6470
  • Fax: 407-894-6872
Mailing address:
  • Phone: 407-398-6470
  • Fax: 407-894-6872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS12838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: