Healthcare Provider Details

I. General information

NPI: 1194852657
Provider Name (Legal Business Name): J. PAONESSA M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 PASADENA AVE S SUITE 400
SOUTH PASADENA FL
33707-4516
US

IV. Provider business mailing address

1201 5TH AVE N SUITE 505
ST PETERSBURG FL
33705-1455
US

V. Phone/Fax

Practice location:
  • Phone: 727-341-1316
  • Fax: 727-345-4000
Mailing address:
  • Phone: 727-821-0017
  • Fax: 727-502-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateFL

VIII. Authorized Official

Name: RYAN CIARROCCHI
Title or Position: CFO
Credential:
Phone: 727-824-4601