Healthcare Provider Details

I. General information

NPI: 1912836677
Provider Name (Legal Business Name): KIANA DESIREE BISSOON CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 TRAFALGAR CT STE 200E
MAITLAND FL
32751-7420
US

IV. Provider business mailing address

4108 GEORGE RD UNIT 2303
TAMPA FL
33634-7569
US

V. Phone/Fax

Practice location:
  • Phone: 407-667-0444
  • Fax: 407-667-0505
Mailing address:
  • Phone: 954-675-1083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: