Healthcare Provider Details

I. General information

NPI: 1174937767
Provider Name (Legal Business Name): EMILY WARRNER-NIX M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11602 LAKE UNDERHILL RD SUITE 129
ORLANDO FL
32825-4458
US

IV. Provider business mailing address

1698 WINGSPAN WAY
WINTER SPRINGS FL
32708-5927
US

V. Phone/Fax

Practice location:
  • Phone: 407-384-2767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA13962
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: