Provider Demographics
NPI:1548143274
Name:SUMMIT PRIMARY CARE PLLC
Entity type:Organization
Organization Name:SUMMIT PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACEMARIE
Authorized Official - Middle Name:ROSARIO
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:321-496-5717
Mailing Address - Street 1:626 N ALAFAYA TRAIL
Mailing Address - Street 2:SUITE 206 PMB1066
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:626 N ALAFAYA TRAIL
Practice Address - Street 2:SUITE 206 PMB1066
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828
Practice Address - Country:US
Practice Address - Phone:321-496-5717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty