Provider Demographics
NPI:1770216392
Name:KAREN L VIDAL PA-C, LLC
Entity Type:Organization
Organization Name:KAREN L VIDAL PA-C, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:VIDAL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:352-427-1326
Mailing Address - Street 1:946 SE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-3910
Mailing Address - Country:US
Mailing Address - Phone:352-427-1326
Mailing Address - Fax:
Practice Address - Street 1:946 SE 10TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-3910
Practice Address - Country:US
Practice Address - Phone:352-427-1326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty