Healthcare Provider Details

I. General information

NPI: 1679250096
Provider Name (Legal Business Name): PAULA MINNICK CME
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25973 US HIGHWAY 19 N
CLEARWATER FL
33763-2013
US

IV. Provider business mailing address

2673 CYPRESS BEND DR
CLEARWATER FL
33761-3811
US

V. Phone/Fax

Practice location:
  • Phone: 727-266-5693
  • Fax:
Mailing address:
  • Phone: 610-639-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberEO4534
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: