Healthcare Provider Details

I. General information

NPI: 1104730670
Provider Name (Legal Business Name): EMMANUELLE CRIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E PRINCETON ST STE 200
ORLANDO FL
32804-5555
US

IV. Provider business mailing address

17806 WESTBAY CT
WINTER GARDEN FL
34787-9430
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-1444
  • Fax:
Mailing address:
  • Phone: 407-403-0559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: