Healthcare Provider Details

I. General information

NPI: 1508060765
Provider Name (Legal Business Name): EMILY KRISTIN FORREST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E PRINCETON ST SUITE 300
ORLANDO FL
32803-1456
US

IV. Provider business mailing address

615 E PRINCETON ST SUITE 300
ORLANDO FL
32803-1456
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-6005
  • Fax: 407-898-7722
Mailing address:
  • Phone: 407-898-6005
  • Fax: 407-898-7722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number235318
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberME112108
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: