Healthcare Provider Details

I. General information

NPI: 1215333943
Provider Name (Legal Business Name): THOMAS DONATO PINO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 DEL PRADO BLVD N
CAPE CORAL FL
33909-2278
US

IV. Provider business mailing address

151 SOUTHHALL LANE SUITE 300
MAITLAND FL
32751-7157
US

V. Phone/Fax

Practice location:
  • Phone: 239-829-7102
  • Fax:
Mailing address:
  • Phone: 866-400-3376
  • Fax: 407-650-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberPA9108370
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9108370
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: