MEDICARE: MRS. PRISCYLLA COOK DMS, PA-C

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	363AM0700X	Medical Physician Assistant	PA9118283	FL

General Provider Information

NPI Number	:	1750012779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PRISCYLLA COOK DMS, PA-C

Provider Business Mailing Address
First Line	:	12139 S APOPKA VINELAND RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32836-6802
Country	:	US
Telephone Number	:	407-591-1076
Fax Number	:

Provider Business Practice Location Address
First Line	:	12139 S APOPKA VINELAND RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32836-6802
Country	:	US
Telephone Number	:	407-535-1313
Fax Number	:	407-778-1479

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

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	06/15/2026

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