=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952531527
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN JOSEPH HISCOCK RPA/RRA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2009
-----------------------------------------------------
Last Update Date | 07/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1414 KUHL AVE
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806-2008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 854-854-1774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1005 SALAMANCA PL
-----------------------------------------------------
City | DAVENPORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33837-9712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-617-2982
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 243U00000X
-----------------------------------------------------
Taxonomy Name | Radiology Practitioner Assistant
-----------------------------------------------------
License Number | RA183
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------