Basic Information
| Provider Information | |||||||||
| NPI: | 1285719476 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARSHALL KRUHM | ||||||||
| FirstName: | LIZA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 BROKEN SOUND PKWY NW | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334873507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612419300 | ||||||||
| FaxNumber: | 5613720214 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 S ORLANDO AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327897109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076225766 | ||||||||
| FaxNumber: | 4076225767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 04/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9103730 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | PA9103730 | 01 | FL | FLORIDA LICENSE | OTHER |