Provider Demographics
NPI:1932127776
Name:LAWSON, ERYN (PA)
Entity Type:Individual
Prefix:
First Name:ERYN
Middle Name:
Last Name:LAWSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ERYN
Other - Middle Name:
Other - Last Name:WENINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1222 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1215
Mailing Address - Country:US
Mailing Address - Phone:321-841-3050
Mailing Address - Fax:321-841-3049
Practice Address - Street 1:1222 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1215
Practice Address - Country:US
Practice Address - Phone:321-841-3050
Practice Address - Fax:321-841-3049
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9103364363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9103364OtherMEDICAL LICENSE
FL292382300Medicaid
FLPA9103364OtherMEDICAL LICENSE