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General NPI Number Information
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NPI Number | 1215534722
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Entity Type | Individual
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Provider Name | PATRICIA YVETTE DE TOMAS-MEDINA PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 603 7TH ST S STE 100
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4719
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Country | US
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Telephone | 727-553-7431
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Fax | 727-553-7432
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Provider Business Mailing Address
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Address Line | 603 7TH ST S STE 100
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4719
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Country | US
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Telephone | 727-553-7431
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Fax | 727-553-7432
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-12043
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-12043
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9119526
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NC
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