Healthcare Provider Details

I. General information

NPI: 1477004711
Provider Name (Legal Business Name): ALLISON MARIE OHLIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3759 PLEASANT HILL RD
KISSIMMEE FL
34746-2937
US

IV. Provider business mailing address

3947 HELENA ST NE
SAINT PETERSBURG FL
33703-6031
US

V. Phone/Fax

Practice location:
  • Phone: 634-192-7238
  • Fax:
Mailing address:
  • Phone: 239-222-3866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109635
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: