Provider Demographics
NPI:1285719476
Name:MARSHALL KRUHM, LIZA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LIZA
Middle Name:
Last Name:MARSHALL KRUHM
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:951 BROKEN SOUND PKWY NW
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3507
Mailing Address - Country:US
Mailing Address - Phone:561-241-9300
Mailing Address - Fax:561-372-0214
Practice Address - Street 1:1201 S ORLANDO AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7109
Practice Address - Country:US
Practice Address - Phone:407-622-5766
Practice Address - Fax:407-622-5767
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2015-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103730363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9103730OtherFLORIDA LICENSE