Healthcare Provider Details

I. General information

NPI: 1881581510
Provider Name (Legal Business Name): DEREK GLENN EIFLANDER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 33RD ST STE 100
ORLANDO FL
32839-8858
US

IV. Provider business mailing address

1724 33RD ST STE 100
ORLANDO FL
32839-8858
US

V. Phone/Fax

Practice location:
  • Phone: 407-553-6336
  • Fax:
Mailing address:
  • Phone: 407-553-6336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11040429
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: