Healthcare Provider Details

I. General information

NPI: 1124031885
Provider Name (Legal Business Name): JAMES R PIOTROWSKI PAC-MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 S INTERNATIONAL PKWY STE 1111
LAKE MARY FL
32746-1407
US

IV. Provider business mailing address

7460 DOCS GROVE CIR
ORLANDO FL
32819-8010
US

V. Phone/Fax

Practice location:
  • Phone: 407-206-3755
  • Fax: 407-206-3762
Mailing address:
  • Phone: 407-903-9360
  • Fax: 407-903-9710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 1789
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 1789
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: