Provider Demographics
NPI:1053982389
Name:TURGEON, KARLY JEAN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KARLY
Middle Name:JEAN MARIE
Last Name:TURGEON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SHERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2684
Mailing Address - Country:US
Mailing Address - Phone:413-313-3951
Mailing Address - Fax:
Practice Address - Street 1:6000 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-2226
Practice Address - Country:US
Practice Address - Phone:954-771-2551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114622.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant