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General NPI Number Information
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NPI Number | 1356135370
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Entity Type | Individual
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Provider Name | PRATIVA ASHANA BHAGWANDIN PA
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Gender | Female
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 395 COMMERCIAL CT STE C
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City | VENICE
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State | FL
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Zip | 34292-1651
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Country | US
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Telephone | 941-529-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 9737 MAGNOLIA VIEW CT APT 201
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City | RIVERVIEW
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State | FL
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Zip | 33578-4649
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Country | US
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Telephone | 608-445-0621
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Fax |
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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 | 9119499
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License Number State | FL
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