Healthcare Provider Details

I. General information

NPI: 1639691215
Provider Name (Legal Business Name): OHANA HEALTH P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SPRING VISTA DR
DEBARY FL
32713
US

IV. Provider business mailing address

50 SPRING VISTA DR
DEBARY FL
32713-1809
US

V. Phone/Fax

Practice location:
  • Phone: 386-748-3900
  • Fax:
Mailing address:
  • Phone: 386-279-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS8737
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTYNA D PARADIS
Title or Position: CEO
Credential: D.O.
Phone: 386-279-3087