MEDICARE: RADOSTINA IVANOVA PAVLOVA ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN9285314	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN9285314	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073985578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RADOSTINA IVANOVA PAVLOVA ARNP

Provider Business Mailing Address
First Line	:	6350 76TH AVE N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-3152
Country	:	US
Telephone Number	:	727-369-3922
Fax Number	:

Provider Business Practice Location Address
First Line	:	6350 76TH AVE N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-3152
Country	:	US
Telephone Number	:	727-369-3922
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2015
Last Update Date	:	11/19/2025

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