Healthcare Provider Details

I. General information

NPI: 1447895370
Provider Name (Legal Business Name): KEIANA SKINNER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LAKELAND HILLS BLVD
LAKELAND FL
33805-3065
US

IV. Provider business mailing address

7028 KIWANO WAY
WINDERMERE FL
34786-6797
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-7271
  • Fax: 866-264-8519
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113823
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number033217
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: