Provider Demographics
NPI:1609368414
Name:PALLE, HYSINTINE (APRN)
Entity type:Individual
Prefix:
First Name:HYSINTINE
Middle Name:
Last Name:PALLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HYSINTINE
Other - Middle Name:
Other - Last Name:PALLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1200 N CENTRAL AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4439
Mailing Address - Country:US
Mailing Address - Phone:240-593-8071
Mailing Address - Fax:
Practice Address - Street 1:1200 N CENTRAL AVE STE 102
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4439
Practice Address - Country:US
Practice Address - Phone:240-593-8071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9408349363LF0000X
FLAPRN9408349363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily