Provider Demographics
NPI:1811998156
Name:KALLE, JANELLE MARIE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:JANELLE
Middle Name:MARIE
Last Name:KALLE
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 1:500 VONDERBURG DR
Mailing Address - Street 2:102
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5964
Mailing Address - Country:US
Mailing Address - Phone:813-386-2547
Mailing Address - Fax:813-681-5250
Practice Address - Street 1:500 VONDERBURG DR
Practice Address - Street 2:102
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5964
Practice Address - Country:US
Practice Address - Phone:813-386-2547
Practice Address - Fax:813-681-5250
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105959363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ33513Medicare UPIN
NC2762586Medicare ID - Type UnspecifiedPROVIDER NUMBER