MEDICARE: ELIZABETH LOUISE SCARLETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1093600587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH LOUISE SCARLETT

Provider Business Mailing Address
First Line	:	443 N JOHN ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-1121
Country	:	US
Telephone Number	:	407-506-4043
Fax Number	:

Provider Business Practice Location Address
First Line	:	443 N JOHN ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-1121
Country	:	US
Telephone Number	:	407-506-4043
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2025
Last Update Date	:	06/12/2025

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