Healthcare Provider Details

I. General information

NPI: 1225580178
Provider Name (Legal Business Name): ERIN O'NEILL D.P.M, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 HILLCREST ST
ORLANDO FL
32801-1211
US

IV. Provider business mailing address

217 HILLCREST ST
ORLANDO FL
32801-1211
US

V. Phone/Fax

Practice location:
  • Phone: 843-422-3308
  • Fax:
Mailing address:
  • Phone: 407-425-1566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO4043
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0116029554
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4043
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9113338
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: