Provider Demographics
NPI:1760957328
Name:TRUDELL, CARA (PA-C)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:TRUDELL
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 1:201 HILDA ST STE 26
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2359
Mailing Address - Country:US
Mailing Address - Phone:407-944-3071
Mailing Address - Fax:407-944-3061
Practice Address - Street 1:201 HILDA ST STE 26
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2359
Practice Address - Country:US
Practice Address - Phone:407-944-3071
Practice Address - Fax:407-944-3061
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111682363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical