1659636264 NPI number — ANDREA CANATA P.A.

Table of content: ANDREA CANATA P.A. (NPI 1659636264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659636264 NPI number — ANDREA CANATA P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANATA
Provider First Name:
ANDREA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLEARY
Provider Other First Name:
ANDREA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659636264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2454 N MCMULLEN BOOTH RD
Provider Second Line Business Mailing Address:
SUITE 601
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33759-1353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-796-7705
Provider Business Mailing Address Fax Number:
727-796-8764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2454 N MCMULLEN BOOTH RD
Provider Second Line Business Practice Location Address:
SUITE 601
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33759-1353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-796-7705
Provider Business Practice Location Address Fax Number:
727-796-8764
Provider Enumeration Date:
07/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA9106229 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 59-3585336 . This is a "FEDERAL TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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