Healthcare Provider Details

I. General information

NPI: 1548098114
Provider Name (Legal Business Name): MADISON K EWING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E PRINCETON ST STE 540
ORLANDO FL
32803-1424
US

IV. Provider business mailing address

615 E PRINCETON ST STE 540
ORLANDO FL
32803-1424
US

V. Phone/Fax

Practice location:
  • Phone: 330-921-8684
  • Fax:
Mailing address:
  • Phone: 407-303-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119306
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: