Liza Marshall Kruhm, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9103730 Issued in FL

Practice address

1201 S Orlando Ave
Suite 200
Winter Park, FL 32789-7109

Phone

(407) 622-5766

Fax

(407) 622-5767

NPI assigned

Oct 26, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429660800000",
    "number": "1285719476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 BROKEN SOUND PKWY NW",
            "address_2": "SUITE 225",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334873507",
            "telephone_number": "561-241-9300",
            "fax_number": "561-372-0214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 S ORLANDO AVE",
            "address_2": "SUITE 200",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327897109",
            "telephone_number": "407-622-5766",
            "fax_number": "407-622-5767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL KRUHM",
        "first_name": "LIZA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2015-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9103730",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA LICENSE",
            "identifier": "PA9103730",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Medical Physician Assistant in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.