MEDICARE: KRISTEN MAZUR PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601012134	MI
2	363A00000X	Physician Assistant	9120531	FL

General Provider Information

NPI Number	:	1427619170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN MAZUR PA-C

Provider Business Mailing Address
First Line	:	1070 N STONE ST STE A
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-0824
Country	:	US
Telephone Number	:	386-943-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1070 N STONE ST STE A
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-0824
Country	:	US
Telephone Number	:	386-943-7100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2019
Last Update Date	:	12/03/2025

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Directions to “ KRISTEN MAZUR PA-C” Practice Location

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