Individual
MICHAEL EDMISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1222 S ORANGE AVE, ORLANDO, FL 32806-1215
(321) 841-6444
(407) 445-3515
Mailing address
1222 S ORANGE AVE, ORLANDO, FL 32806-1215
(321) 841-6444
(407) 445-3515
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9113231
FL
363AM0700X
Medical Physician Assistant
Primary
PA9113231
FL
Other
Enumeration date
12/26/2019
Last updated
02/13/2024
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