Provider Demographics
NPI:1285604900
Name:KOGOY, CHRISTINE A (PA)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:A
Last Name:KOGOY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N ORANGE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-7613
Mailing Address - Country:US
Mailing Address - Phone:800-277-6819
Mailing Address - Fax:407-386-6239
Practice Address - Street 1:3000 N ORANGE AVE STE C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7613
Practice Address - Country:US
Practice Address - Phone:800-277-6819
Practice Address - Fax:407-386-6239
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3425363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291544800Medicaid
E1879ZMedicare PIN
FLS34611Medicare UPIN
FLE1879YMedicare PIN