Healthcare Provider Details

I. General information

NPI: 1972610020
Provider Name (Legal Business Name): CARA C CIMILLUCA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6774 102ND AVE N
PINELLAS PARK FL
33782-2909
US

IV. Provider business mailing address

6774 102ND AVE N
PINELLAS PARK FL
33782-2909
US

V. Phone/Fax

Practice location:
  • Phone: 727-289-0062
  • Fax: 727-324-1865
Mailing address:
  • Phone: 727-289-0062
  • Fax: 727-324-1865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9104283
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9104283
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: