Healthcare Provider Details

I. General information

NPI: 1750675161
Provider Name (Legal Business Name): KATHLEEN A. CRICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 W UNDERWOOD ST SUITE 202
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

734 S MILLS AVE
ORLANDO FL
32801-4212
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-6876
  • Fax: 407-872-0544
Mailing address:
  • Phone: 904-318-4680
  • Fax: 407-872-0544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number120486
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number120486
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: