Provider Demographics
NPI:1124651328
Name:HUNT, KAYLEIGH E (PA-C)
Entity type:Individual
Prefix:MS
First Name:KAYLEIGH
Middle Name:E
Last Name:HUNT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAYLEIGH
Other - Middle Name:
Other - Last Name:POULIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:89 W COPELAND DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2002
Mailing Address - Country:US
Mailing Address - Phone:321-841-7550
Mailing Address - Fax:321-841-8185
Practice Address - Street 1:89 W COPELAND DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2002
Practice Address - Country:US
Practice Address - Phone:321-841-7550
Practice Address - Fax:321-841-8185
Is Sole Proprietor?:No
Enumeration Date:2020-02-16
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
FLPA9113285363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant