Healthcare Provider Details

I. General information

NPI: 1043652134
Provider Name (Legal Business Name): ERIN N ALLENDORFER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 2ND ST E
BRADENTON FL
34208-1042
US

IV. Provider business mailing address

367 S. GULPH RD ATT IPM CREDENTIALING
KING OF PRUSSIA PA
19406-3121
US

V. Phone/Fax

Practice location:
  • Phone: 941-746-5111
  • Fax: 941-745-7233
Mailing address:
  • Phone: 610-382-4943
  • Fax: 610-878-3965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9110723
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: