# CICATRIX OF WINTER PARK LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518848969
- **Authorized official:** JEREMY PAUL EWBANK (OWNER)
- **Authorized official phone:** (407) 449-2645

## Contact information

- **Practice address:** 1270 ORANGE AVE STE D1, WINTER PARK, FL 32789-4946
- **Practice address phone:** (407) 587-5559
- **Mailing address:** 1270 ORANGE AVE STE D1, WINTER PARK, FL 32789-4946
- **Mailing address phone:** (407) 587-5559

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 363AS0400X | Surgical Physician Assistant | — | NULL | Yes |
| 363AS0400X | Surgical Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 09/11/2025
- **Last updated:** 09/11/2025