Healthcare Provider Details

I. General information

NPI: 1447719125
Provider Name (Legal Business Name): ALBERTO G MINNOCCI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 N UNIVERSITY DR
CORAL SPRINGS FL
33071-6001
US

IV. Provider business mailing address

1809 N UNIVERSITY DR
CORAL SPRINGS FL
33071-6001
US

V. Phone/Fax

Practice location:
  • Phone: 954-510-1900
  • Fax:
Mailing address:
  • Phone: 954-510-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9111774
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9111774
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: