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General NPI Number Information
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NPI Number | 1396176103
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Entity Type | Organization
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Legal Business Name | PA RESOURCES, INC.
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 27032 HOLLYBROOK TRL
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-7434
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Country | US
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Telephone | 813-345-4444
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Fax | 813-333-0445
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Provider Business Mailing Address
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Address Line | 27032 HOLLYBROOK TRL
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-7434
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Country | US
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Telephone | 813-345-4444
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Fax | 813-333-0445
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Authorized Official
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Title or Position | CREDENTIALER
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Name | MR. JERRY LYNN GODDING
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Credential | ESQ.
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Telephone | 727-485-8900
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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 | PA3323
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License Number State | FL
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