Provider Demographics
NPI:1174517429
Name:DRISCOLL, KAREN E (M D P A)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:M D P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 S ALTERNATE A1A
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-4063
Mailing Address - Country:US
Mailing Address - Phone:561-747-7808
Mailing Address - Fax:561-747-7898
Practice Address - Street 1:2141 S ALTERNATE A1A
Practice Address - Street 2:SUITE 100
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4063
Practice Address - Country:US
Practice Address - Phone:561-747-7808
Practice Address - Fax:561-747-7898
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50975207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10098Medicare ID - Type Unspecified
E66208Medicare UPIN