MEDICARE: MS. KARINA IVON AUZA DE RYVNINE 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	PA9104637	FL

General Provider Information

NPI Number	:	1932359486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARINA IVON AUZA DE RYVNINE PA-C

Provider Business Mailing Address
First Line	:	930 MARCUM RD
Second Line	:	SUITE 12
City	:	LAKELAND
State	:	FL
Zip	:	33809-4308
Country	:	US
Telephone Number	:	863-853-3331
Fax Number	:	863-853-3337

Provider Business Practice Location Address
First Line	:	930 MARCUM RD
Second Line	:	SUITE 12
City	:	LAKELAND
State	:	FL
Zip	:	33809-4308
Country	:	US
Telephone Number	:	863-853-3331
Fax Number	:	863-853-3337

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

Provider Enumeration Date	:	09/21/2008
Last Update Date	:	09/21/2008

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