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Individual

EMMANUEL O OKELOLA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
89 W COPELAND DR, ORLANDO, FL 32806-2002
(321) 841-7550
(321) 841-8185
Mailing address
89 W COPELAND DR, ORLANDO, FL 32806-2002
(321) 841-7550
(321) 841-8185

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
9112549
FL
363AS0400X
Surgical Physician Assistant
Primary
PA9112549
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
104577400
FL
Enumeration date
09/27/2019
Last updated
01/10/2020
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