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General NPI Number Information
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NPI Number | 1073568747
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Entity Type | Individual
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Provider Name | ANTHONY A. AZZARELLO PA
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 303 NO. CLYDE MORRIS BLVD. HALIFAX MEDICAL CENTER - CHEST PAIN CENTER
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2709
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Country | US
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Telephone | 386-425-1800
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Fax | 386-425-1804
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Provider Business Mailing Address
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Address Line | PO BOX BOX 864074 HALIFAX HEALTHCARE SYSTEMS, INC.
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City | ORLANDO
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State | FL
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Zip | 32886-4074
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Country | US
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Telephone | 386-226-4590
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Fax | 386-226-3371
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9103151
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License Number State | FL
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