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NPI Code Detail

MEDICARE: ANGELO M LABRACIO P.A.

MEDICARE: ANGELO M LABRACIO P.A.
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
1363AM0700XMedical Physician AssistantPA9101406FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891780722
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELO M LABRACIO P.A.
Provider Business Mailing Address
First Line : PO BOX 863407
Second Line :
City : ORLANDO
State : FL
Zip : 32886-3407
Country : US
Telephone Number : 941-917-2600
Fax Number : 941-917-7884
Provider Business Practice Location Address
First Line : 1700 S TAMIAMI TRL
Second Line :
City : SARASOTA
State : FL
Zip : 34239-3509
Country : US
Telephone Number : 941-917-4896
Fax Number : 941-917-6884
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2005
Last Update Date : 12/04/2020

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