Provider Demographics
NPI:1407306129
Name:MARKHAM, ERIN CHRISTINE
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:CHRISTINE
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5722
Mailing Address - Country:US
Mailing Address - Phone:407-654-6506
Mailing Address - Fax:407-636-7801
Practice Address - Street 1:414 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803
Practice Address - Country:US
Practice Address - Phone:407-654-6506
Practice Address - Fax:407-636-7801
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9247430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101156700Medicaid