Healthcare Provider Details

I. General information

NPI: 1295770691
Provider Name (Legal Business Name): GREGG ALAN KASINGER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 SE 16TH AVE STE 303
OCALA FL
34471-4620
US

IV. Provider business mailing address

1720 SE 16TH AVE STE 303
OCALA FL
34471-4620
US

V. Phone/Fax

Practice location:
  • Phone: 352-369-0288
  • Fax: 352-867-1053
Mailing address:
  • Phone: 352-369-0288
  • Fax: 352-867-1053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3131
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA3131
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: