Healthcare Provider Details

I. General information

NPI: 1437479714
Provider Name (Legal Business Name): AUTUMN FAITH ELMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W FAIRBANKS AVE STE 220
WINTER PARK FL
32789-4777
US

IV. Provider business mailing address

1111 W FAIRBANKS AVE STE 220
WINTER PARK FL
32789-4777
US

V. Phone/Fax

Practice location:
  • Phone: 407-635-3024
  • Fax: 321-203-4626
Mailing address:
  • Phone: 407-635-3024
  • Fax: 321-203-4626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME118140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: