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1962047670 NPI number — ANNAMARIE KISGEROPOULOS PA-C

NPI Number: 1962047670
Health Care Provider/Practitioner: ANNAMARIE KISGEROPOULOS PA-C

Information about “1962047670” NPI (ANNAMARIE KISGEROPOULOS PA-C) exists in 1962047670 in HTML format HTML  |  1962047670 in plain Text format TXT  |  1962047670 in PDF (Portable Document Format) PDF  |  1962047670 in an XML format XML  formats.

NPI Number : 1962047670 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962047670",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KISGEROPOULOS",
    "FirstName": "ANNAMARIE",
    "MiddleName": null,
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6213 WOODHAVEN VILLAGE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORT ORANGE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32128-6850",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "386-341-0652",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "305 MEMORIAL MEDICAL PKWY STE 206",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DAYTONA BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32117-5169",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "407-384-7388",
    "PracticeLocationAddressFaxNumber": "407-384-1140",
    "EnumerationDate": "11/18/2019",
    "LastUpdateDate": "01/12/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208C00000X",
          "TaxonomyName": "Colon & Rectal Surgery Physician",
          "LicenseNumber": "9112758",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA9112758",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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