Provider Demographics
NPI:1053973248
Name:PROSSER, EMMA GRACE (APRN)
Entity type:Individual
Prefix:MS
First Name:EMMA
Middle Name:GRACE
Last Name:PROSSER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:EMMA
Other - Middle Name:GRACE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1222 S ORANGE AVE 2ND FL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1106
Mailing Address - Country:US
Mailing Address - Phone:321-841-1700
Mailing Address - Fax:321-841-1906
Practice Address - Street 1:1222 S ORANGE AVE 2ND FL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1106
Practice Address - Country:US
Practice Address - Phone:321-843-3220
Practice Address - Fax:321-843-3210
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002134363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103757400Medicaid