Healthcare Provider Details

I. General information

NPI: 1598851982
Provider Name (Legal Business Name): KRISTEN A DIEHL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801. N ORANGE AVE
ORLANDO FL
32801
US

IV. Provider business mailing address

1900 N MILLS AVE
ORLANDO FL
32803-1444
US

V. Phone/Fax

Practice location:
  • Phone: 407-992-0660
  • Fax: 407-992-0660
Mailing address:
  • Phone: 407-894-4880
  • Fax: 407-894-2364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102040
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: