Provider Demographics
NPI:1063441814
Name:KUGLER-CLARK, LYNN J (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:J
Last Name:KUGLER-CLARK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W MORSE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3731
Mailing Address - Country:US
Mailing Address - Phone:407-629-8121
Mailing Address - Fax:407-629-7250
Practice Address - Street 1:701 W MORSE BLVD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3731
Practice Address - Country:US
Practice Address - Phone:407-629-8121
Practice Address - Fax:407-629-7250
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100866363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9100866OtherPA LICENSE NUMBER