MEDICARE: QUINTENSIA LOLITA GAITAN-HARRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9111409	FL

General Provider Information

NPI Number	:	1477033496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUINTENSIA LOLITA GAITAN-HARRIS

Provider Business Mailing Address
First Line	:	6224 PADDOCK GLEN DR UNIT 208
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-5368
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	37912 CHURCH AVE
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-4207
Country	:	US
Telephone Number	:	407-274-7624
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	08/20/2018

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