Individual
SHIRLEY J HOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
1400 S ORANGE AVE, ORLANDO, FL 32806-2134
(321) 843-8010
(321) 843-6330
Mailing address
1400 S ORANGE AVE, ORLANDO, FL 32806-2134
(321) 843-8010
(321) 843-6330
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9102291
FL
363AM0700X
Medical Physician Assistant
Primary
PA9102291
FL
363AS0400X
Surgical Physician Assistant
PA9102291
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291475100
—
FL
01
—
E8990G
MEDICARE GROUP PTAN
FL
Enumeration date
09/16/2005
Last updated
07/19/2024
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