Healthcare Provider Details

I. General information

NPI: 1871488619
Provider Name (Legal Business Name): EMILY SCANLON MEDAL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY REAGAN SCANLON RN

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST, ORLANDO, FL 32803
ORLANDO FL
32789
US

IV. Provider business mailing address

1643 ELIZABETHS WALK
WINTER PARK FL
32789-5947
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-5600
  • Fax:
Mailing address:
  • Phone: 407-919-9461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number154790
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11040201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: