Provider Demographics
NPI:1265151617
Name:HUSAIN, AHLA (PA)
Entity type:Individual
Prefix:
First Name:AHLA
Middle Name:
Last Name:HUSAIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AHLA
Other - Middle Name:
Other - Last Name:HUSAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:1403 MEDICAL PLAZA DR STE 207
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1047
Mailing Address - Country:US
Mailing Address - Phone:321-364-0728
Mailing Address - Fax:321-364-0729
Practice Address - Street 1:1403 MEDICAL PLAZA DR STE 207
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1047
Practice Address - Country:US
Practice Address - Phone:321-364-0728
Practice Address - Fax:321-364-0729
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1363PA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1363OtherPHYSICIAN ASSISTANT