Provider Demographics
NPI:1992907273
Name:CASEY, KRISTIN L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:L
Last Name:CASEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-5536
Mailing Address - Country:US
Mailing Address - Phone:352-735-1400
Mailing Address - Fax:352-735-3300
Practice Address - Street 1:250 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-5536
Practice Address - Country:US
Practice Address - Phone:352-735-1400
Practice Address - Fax:352-735-3300
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104709363A00000X
CT001796363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant