| Orlando Immunology Center Pa | |
|
1707 N Mills Ave Orlando FL 32803-1851 | |
| (407) 647-3960 | |
| (407) 413-5775 |
| Full Name | Orlando Immunology Center Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 1707 N Mills Ave, Orlando, Florida |
| Authorized Official Name and Position | Edwin Dejesus (OWNER) |
| Authorized Official Contact | 4076473960 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Orlando Immunology Center Pa 1707 N Mills Ave Orlando FL 32803-1851 Ph: (407) 647-3960 | Orlando Immunology Center Pa 1707 N Mills Ave Orlando FL 32803-1851 Ph: (407) 647-3960 |
| NPI Number | 1467003772 |
|---|---|
| Provider Enumeration Date | 09/27/2019 |
| Last Update Date | 05/08/2024 |
| Medicare PECOS PAC ID | 4688007495 |
|---|---|
| Medicare Enrollment ID | O20191210000800 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467003772 | NPI | - | NPPES |
| 104671400 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Terry L Wilder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518906072 PECOS PAC ID: 7416051875 Enrollment ID: I20090320000532 |
| Provider Name | Stephanie J Skipper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124101266 PECOS PAC ID: 7517015670 Enrollment ID: I20090429000009 |
| Provider Name | Federico Hinestrosa |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1427215557 PECOS PAC ID: 1254483225 Enrollment ID: I20090722000489 |
| Provider Name | Edwin Dejesus |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1295734101 PECOS PAC ID: 2961538236 Enrollment ID: I20100326000225 |
| Provider Name | Jeffrey Prentiss Garrett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558650762 PECOS PAC ID: 1557545779 Enrollment ID: I20110413000628 |
| Provider Name | Dan O Cruz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134430374 PECOS PAC ID: 1355578972 Enrollment ID: I20160331002169 |
| Provider Name | Charlotte-paige Rolle |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1023338878 PECOS PAC ID: 7719259902 Enrollment ID: I20170823001789 |
| Provider Name | Michael Seibert |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1134380298 PECOS PAC ID: 5799925087 Enrollment ID: I20210914001107 |
| Provider Name | Angela Eakels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659863843 PECOS PAC ID: 3173878501 Enrollment ID: I20230228000079 |
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