Provider Demographics
NPI:1881625614
Name:WHITTAKER, DENISE H (PA C)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:H
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:HEATHER
Other - Last Name:WHITTAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1601 SW ARCHER RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1135
Mailing Address - Country:US
Mailing Address - Phone:352-376-1611
Mailing Address - Fax:352-271-4575
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:352-271-4575
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3655363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292001800Medicaid
FL292001800Medicaid
FLE2906XMedicare PIN