Healthcare Provider Details

I. General information

NPI: 1922158435
Provider Name (Legal Business Name): DANIEL S KREISMAN P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N SUMMIT ST
CRESCENT CITY FL
32112-2191
US

IV. Provider business mailing address

185 KINGFISH RD
POMONA PARK FL
32181-2424
US

V. Phone/Fax

Practice location:
  • Phone: 386-698-2279
  • Fax: 386-698-2239
Mailing address:
  • Phone: 386-649-3004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 0003478
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: