Healthcare Provider Details

I. General information

NPI: 1366953135
Provider Name (Legal Business Name): KELSEY HOBLICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 W PLYMOUTH AVE
DELAND FL
32720-3284
US

IV. Provider business mailing address

844 W PLYMOUTH AVE
DELAND FL
32720-3284
US

V. Phone/Fax

Practice location:
  • Phone: 386-738-2422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9110807
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: