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Individual

KAREN L. VIDAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
29253 US HIGHWAY 19 N, CLEARWATER, FL 33761-2102
(727) 313-4764
(727) 313-4764
Mailing address
946 SE 10TH ST, OCALA, FL 34471-3910
(352) 427-1326

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA 2828
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2927853 00
FL
01
E1096T
QSS SCS PTAN
FL
01
P00108704
MEDICARE RR
FL
Enumeration date
06/21/2006
Last updated
12/02/2020
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