Provider Demographics
NPI:1356498307
Name:KALTENBACH, JUDITH ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:KALTENBACH
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 1:1200 W SR 434 STE 112
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4957
Mailing Address - Country:US
Mailing Address - Phone:407-869-8747
Mailing Address - Fax:407-869-8108
Practice Address - Street 1:1200 W SR 434 STE 112
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4957
Practice Address - Country:US
Practice Address - Phone:407-869-8747
Practice Address - Fax:407-869-8108
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA 3205OtherLICENSE PHYSICIAN ASSISTA