=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730598525
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KHRYSTYNA SPLAVNYK PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2014
-----------------------------------------------------
Last Update Date | 12/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2021 E COMMERCIAL BLVD STE 302
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33308-3754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-463-6408
-----------------------------------------------------
Fax | 954-463-9208
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1419 SE 8TH TER STE 200
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33990-3213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA9112028
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------