Healthcare Provider Details

I. General information

NPI: 1609285949
Provider Name (Legal Business Name): ERIKA WIREBAUGH MED, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1573 W FAIRBANKS AVE STE 100
WINTER PARK FL
32789-4679
US

IV. Provider business mailing address

1573 W FAIRBANKS AVE STE 100
WINTER PARK FL
32789-4679
US

V. Phone/Fax

Practice location:
  • Phone: 419-283-3487
  • Fax:
Mailing address:
  • Phone: 407-896-8097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9120977
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: