Healthcare Provider Details

I. General information

NPI: 1124363650
Provider Name (Legal Business Name): KATHERINE MARIE MARHALIK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE TRUSCELLO P.A.-C

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 WINTER GARDEN VINELAND RD STE 206
WINDERMERE FL
34786-6098
US

IV. Provider business mailing address

5151 WINTER GARDEN VINELAND RD STE 206
WINDERMERE FL
34786-6098
US

V. Phone/Fax

Practice location:
  • Phone: 407-573-3360
  • Fax: 407-643-2811
Mailing address:
  • Phone: 407-573-3360
  • Fax: 407-643-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-03835
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9109684
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109684
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: