Provider Demographics
NPI:1548098114
Name:EWING, MADISON K (PA-C)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:K
Last Name:EWING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E PRINCETON ST STE 540
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1424
Mailing Address - Country:US
Mailing Address - Phone:407-303-9980
Mailing Address - Fax:
Practice Address - Street 1:615 E PRINCETON ST STE 540
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1424
Practice Address - Country:US
Practice Address - Phone:330-921-8684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9119306363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant