MEDICARE: ANTHONY JOHN MUSINGO PA-C

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	363AM0700X	Medical Physician Assistant	PA9108787	FL

General Provider Information

NPI Number	:	1780696815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY JOHN MUSINGO PA-C

Provider Business Mailing Address
First Line	:	5068 ANNUNCIATION CIR UNIT 111
Second Line	:
City	:	AVE MARIA
State	:	FL
Zip	:	34142-9668
Country	:	US
Telephone Number	:	239-867-4395
Fax Number	:	239-217-3662

Provider Business Practice Location Address
First Line	:	5068 ANNUNCIATION CIR
Second Line	:	111
City	:	AVE MARIA
State	:	FL
Zip	:	34142-9667
Country	:	US
Telephone Number	:	239-867-4395
Fax Number	:	239-217-3662

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	06/29/2024

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