Provider Demographics
NPI:1093902090
Name:PRZYSTUP, KAREN LOUISE (ARNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LOUISE
Last Name:PRZYSTUP
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE STE 689
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4648
Mailing Address - Country:US
Mailing Address - Phone:407-303-2024
Mailing Address - Fax:407-303-2038
Practice Address - Street 1:2501 N ORANGE AVE STE 689
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4648
Practice Address - Country:US
Practice Address - Phone:407-303-2024
Practice Address - Fax:407-303-2038
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3079472363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304538200Medicaid
FLE7284ZMedicare PIN
FL304538200Medicaid