Provider Demographics
NPI:1154868008
Name:PATEL, KRISHNA
Entity Type:Individual
Prefix:
First Name:KRISHNA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15035 NE HIGHWAY 315
Mailing Address - Street 2:
Mailing Address - City:FORT MC COY
Mailing Address - State:FL
Mailing Address - Zip Code:32134-2200
Mailing Address - Country:US
Mailing Address - Phone:352-236-2525
Mailing Address - Fax:352-236-8610
Practice Address - Street 1:15035 NE HIGHWAY 315
Practice Address - Street 2:
Practice Address - City:FORT MC COY
Practice Address - State:FL
Practice Address - Zip Code:32134-2200
Practice Address - Country:US
Practice Address - Phone:352-236-2525
Practice Address - Fax:352-236-8610
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9110123363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant