Provider Demographics
NPI:1023254240
Name:PAZ, KAREN (PA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:PAZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 SAN FILIPPO DR SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-2200
Mailing Address - Country:US
Mailing Address - Phone:321-725-8300
Mailing Address - Fax:321-725-1555
Practice Address - Street 1:20 SAN FILIPPO DR SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-2200
Practice Address - Country:US
Practice Address - Phone:321-725-8300
Practice Address - Fax:321-725-1555
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA 9104755363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA 9104755OtherSTATE LICENSURE