Healthcare Provider Details

I. General information

NPI: 1972301372
Provider Name (Legal Business Name): TATIANA IDROBO MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10111 FOREST HILL BLVD RM 100
WELLINGTON FL
33414-6141
US

IV. Provider business mailing address

10111 FOREST HILL BLVD RM 100
WELLINGTON FL
33414-6141
US

V. Phone/Fax

Practice location:
  • Phone: 561-798-1649
  • Fax: 561-791-8631
Mailing address:
  • Phone: 561-798-1649
  • Fax: 561-791-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: