Healthcare Provider Details

I. General information

NPI: 1508640657
Provider Name (Legal Business Name): EMILY DEUTCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7751 PALMETTO CT
PINECREST FL
33156-5201
US

IV. Provider business mailing address

7751 PALMETTO CT
PINECREST FL
33156-5201
US

V. Phone/Fax

Practice location:
  • Phone: 305-799-6482
  • Fax:
Mailing address:
  • Phone: 305-799-6482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9117751
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: