Healthcare Provider Details

I. General information

NPI: 1033409131
Provider Name (Legal Business Name): EMILY C OSE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 W MILLER ST # MP38
ORLANDO FL
32806-2031
US

IV. Provider business mailing address

83 W MILLER ST
ORLANDO FL
32806-2031
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-8393
  • Fax: 321-841-7941
Mailing address:
  • Phone: 321-841-8393
  • Fax: 321-841-7941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9105762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: