Healthcare Provider Details

I. General information

NPI: 1174807275
Provider Name (Legal Business Name): AMBER BRAITHWAITE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 N ORLANDO AVENUE SUITE 303
WINTER PARK FL
32789
US

IV. Provider business mailing address

1071 N ORLANDO AVENUE SUITE 303
WINTER PARK FL
32789
US

V. Phone/Fax

Practice location:
  • Phone: 407-821-7934
  • Fax: 407-505-3661
Mailing address:
  • Phone: 407-821-7934
  • Fax: 407-505-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209009126
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209009126
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11032355
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: