=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881370708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTONY F AZIZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2023
-----------------------------------------------------
Last Update Date | 07/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 S PENINSULA DR
-----------------------------------------------------
City | DAYTONA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32118-4422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-310-2160
-----------------------------------------------------
Fax | 386-310-2106
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 MIDWAY PARK DR
-----------------------------------------------------
City | NORTH DARTMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-386-9631
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA9120285
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------