Cicatrix of Winter Park LLC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Legal business name

CICATRIX OF WINTER PARK LLC

Practice address

1270 Orange Ave Ste D1
Winter Park, FL 32789-4946

Phone

(407) 587-5559

NPI assigned

Sep 11, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeremy Paul Ewbank

Title

Owner

Phone

(407) 449-2645

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1757548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1518848969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1270 ORANGE AVE STE D1",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327894946",
            "telephone_number": "407-587-5559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1270 ORANGE AVE STE D1",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327894946",
            "telephone_number": "407-587-5559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CICATRIX OF WINTER PARK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-11",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "EWBANK",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-449-2645"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ishmael Christian
• Christopher W. Conavay, M.D., P.a.
• Unju Chung-Canine, MA LMHC NCC
• Nicholas Chung, DMD
• Coleen N. Cicale, MSW
• Meghan Kathleen Ciccarello, DNP
• Ryan Ciesielski, DPT
• Genevieve Cintron, M.A., CCC-SLP
• City of Winter Park (Winter Park Fire Rescue Department)
• Joa Macnalie Claircius, EDD

• Surgical Physician Assistant in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.