Healthcare Provider Details

I. General information

NPI: 1013572536
Provider Name (Legal Business Name): DANIELA QUINTANA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELA MARTINOLI

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 10TH ST N
ST PETERSBURG FL
33705-1407
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-824-8243
  • Fax: 727-824-8233
Mailing address:
  • Phone: 727-315-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9400
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9114354
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: