Healthcare Provider Details

I. General information

NPI: 1376092973
Provider Name (Legal Business Name): DAVID SEAN MIDDLETON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2016
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 DOCTORS DR
ENGLEWOOD FL
34223-3992
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 941-460-1300
  • Fax: 866-504-3674
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109807
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: