Provider Demographics
NPI:1326115478
Name:KITSLAAR, ANNE M (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:KITSLAAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:483 N SEMORAN BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3803
Mailing Address - Country:US
Mailing Address - Phone:407-645-1847
Mailing Address - Fax:321-274-0246
Practice Address - Street 1:483 N SEMORAN BLVD
Practice Address - Street 2:STE 102
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3803
Practice Address - Country:US
Practice Address - Phone:407-645-1847
Practice Address - Fax:321-274-0246
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA0002568363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical