Healthcare Provider Details

I. General information

NPI: 1790724896
Provider Name (Legal Business Name): JAMES R. CIPRIANO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MAIN ST
DUNEDIN FL
34698-5848
US

IV. Provider business mailing address

PO BOX 67268
ST PETERSBURG FL
33736-7268
US

V. Phone/Fax

Practice location:
  • Phone: 727-733-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3379
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: