Healthcare Provider Details

I. General information

NPI: 1437814951
Provider Name (Legal Business Name): KRISTEN COMITO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 MAITLAND AVE STE 116
ALTAMONTE SPRINGS FL
32701-4913
US

IV. Provider business mailing address

251 MAITLAND AVE STE 116
ALTAMONTE SPRINGS FL
32701-4913
US

V. Phone/Fax

Practice location:
  • Phone: 407-951-5643
  • Fax:
Mailing address:
  • Phone: 407-915-5643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9115269
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: