Individual
KRISTEN LEIGH EASEY WACKELIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1540 S. TAMIAMI TRAIL, SUITE 401, SARASOTA, FL 34239
(941) 917-0060
(941) 957-4248
Mailing address
126 WOODRUFF RD, FARMINGTON, CT 06032-2030
(941) 284-3850
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9108005
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012578900
—
FL
Enumeration date
07/02/2014
Last updated
05/01/2024
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