MEDICARE: MS. PATRICIA A. CERAVOLO P.A.

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	PA9101506	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	E6959W	OTHER	FL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	59-2537613	OTHER	FL	TAX ID

General Provider Information

NPI Number	:	1871562306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA A. CERAVOLO P.A.

Provider Business Mailing Address
First Line	:	2001 SIESTA DR
Second Line	:	SUITE 201
City	:	SARASOTA
State	:	FL
Zip	:	34239-5200
Country	:	US
Telephone Number	:	941-365-5582
Fax Number	:	941-365-5581

Provider Business Practice Location Address
First Line	:	2001 SIESTA DR
Second Line	:	SUITE 201
City	:	SARASOTA
State	:	FL
Zip	:	34239-5200
Country	:	US
Telephone Number	:	941-365-5582
Fax Number	:	941-365-5581

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	11/09/2018

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