Healthcare Provider Details

I. General information

NPI: 1326017757
Provider Name (Legal Business Name): CHARLES P KRONENTHAL JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6279 N LECANTO HWY
BEVERLY HILLS FL
34465-2503
US

IV. Provider business mailing address

14690 SPRING HILL DR STE 305
SPRING HILL FL
34609-8102
US

V. Phone/Fax

Practice location:
  • Phone: 352-522-0094
  • Fax: 352-522-0098
Mailing address:
  • Phone: 352-277-5348
  • Fax: 352-606-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 9104143
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: