Healthcare Provider Details

I. General information

NPI: 1912199019
Provider Name (Legal Business Name): ALLISON ESPOSITO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S ORANGE AVE
ORLANDO FL
32806-2134
US

IV. Provider business mailing address

PO BOX 628296
ORLANDO FL
32862-8296
US

V. Phone/Fax

Practice location:
  • Phone: 407-351-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104196
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007726
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: