Healthcare Provider Details

I. General information

NPI: 1902430259
Provider Name (Legal Business Name): PAULA ANDREA ARDILA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CELEBRATION PLACE STE 208
CELEBRATION FL
34747-5434
US

IV. Provider business mailing address

410 CELEBRATION PLACE STE 208
CELEBRATION FL
34747-5434
US

V. Phone/Fax

Practice location:
  • Phone: 877-800-0239
  • Fax: 407-566-2499
Mailing address:
  • Phone: 877-800-0239
  • Fax: 407-566-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9112892
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112892
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9112892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: