Healthcare Provider Details

I. General information

NPI: 1053643650
Provider Name (Legal Business Name): KRISTEN C LOHSER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN ELIZABETH COLELLO PA-C

II. Dates (important events)

Enumeration Date: 02/06/2010
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 ROUSE RD
ORLANDO FL
32817-2117
US

IV. Provider business mailing address

1201 PAR VIEW DR
SANIBEL FL
33957-6401
US

V. Phone/Fax

Practice location:
  • Phone: 385-220-6257
  • Fax:
Mailing address:
  • Phone: 917-318-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.01039RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15627
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number013896
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113528
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: