Provider Demographics
NPI:1932359486
Name:AUZA DE RYVNINE, KARINA IVON (PA-C)
Entity type:Individual
Prefix:MS
First Name:KARINA
Middle Name:IVON
Last Name:AUZA DE RYVNINE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KARINA
Other - Middle Name:IVON
Other - Last Name:AUZA ROJAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:930 MARCUM RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-4308
Mailing Address - Country:US
Mailing Address - Phone:863-853-3331
Mailing Address - Fax:863-853-3337
Practice Address - Street 1:930 MARCUM RD
Practice Address - Street 2:SUITE 12
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-4308
Practice Address - Country:US
Practice Address - Phone:863-853-3331
Practice Address - Fax:863-853-3337
Is Sole Proprietor?:No
Enumeration Date:2008-09-21
Last Update Date:2008-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104637363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant