Healthcare Provider Details

I. General information

NPI: 1548930498
Provider Name (Legal Business Name): STEPHANIE MARIE COLLADO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE MARIE ORTIZ

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

1222 S ORANGE AVE SUITE 5TH FLOOR, MP 25
ORLANDO FL
32806-1215
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-7700
  • Fax: 321-841-7799
Mailing address:
  • Phone: 321-841-7700
  • Fax: 321-841-7799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9115127
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: