Individual
COLIN PENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
25 W CRYSTAL LAKE ST, STE 200, ORLANDO, FL 32806-4475
(407) 254-2500
(407) 423-2789
Mailing address
25 W CRYSTAL LAKE ST, STE 200, ORLANDO, FL 32806-4475
(407) 254-2500
(407) 423-2789
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9015099
FL
363AS0400X
Surgical Physician Assistant
9105099
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001514400
—
FL
Enumeration date
10/30/2009
Last updated
01/15/2015
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