=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508167040
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF ORLANDO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2010
-----------------------------------------------------
Last Update Date | 02/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 78 W CENTRAL BLVD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32801-2457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-246-3125
-----------------------------------------------------
Fax | 407-246-2758
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 78 W CENTRAL BLVD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32801-2457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-246-3125
-----------------------------------------------------
Fax | 407-246-2758
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FISCAL MANAGER
-----------------------------------------------------
Name | TYSHA RESNICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-246-3131
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 3136
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------