Provider Demographics
NPI:1871562306
Name:CERAVOLO, PATRICIA A (PA)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:CERAVOLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 SIESTA DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5200
Mailing Address - Country:US
Mailing Address - Phone:941-365-5582
Mailing Address - Fax:941-365-5581
Practice Address - Street 1:2001 SIESTA DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5200
Practice Address - Country:US
Practice Address - Phone:941-365-5582
Practice Address - Fax:941-365-5581
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101506363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-2537613OtherTAX ID
FLE6959WOtherMEDICARE PTAN
FLP51230Medicare UPIN