Individual
EMMA ELIZABETH KISSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-0294
(352) 273-7584
(352) 392-3498
Mailing address
PO BOX 100294, GAINESVILLE, FL 32610-0294
(954) 604-1456
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9112284
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104167000
—
FL
Enumeration date
05/09/2019
Last updated
10/23/2019
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