Healthcare Provider Details

I. General information

NPI: 1952999088
Provider Name (Legal Business Name): ERIC PAUL KINGSLEY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 N ORANGE AVE STE 700
ORLANDO FL
32804-5521
US

IV. Provider business mailing address

9 GALEN ST
WATERTOWN MA
02472-4515
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2474
  • Fax: 407-303-0680
Mailing address:
  • Phone: 857-304-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116420
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberPA9116420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: