Provider Demographics
NPI:1063579845
Name:BOYLE, MARIA ANGELICA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ANGELICA
Last Name:BOYLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:ANGELICA
Other - Last Name:RAFFINAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:920 S. MYRTLE AVE
Mailing Address - Street 2:STE#A
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3918
Mailing Address - Country:US
Mailing Address - Phone:727-462-0444
Mailing Address - Fax:727-462-0446
Practice Address - Street 1:920 S. MYRTLE AVE
Practice Address - Street 2:STE#A
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3918
Practice Address - Country:US
Practice Address - Phone:727-462-0444
Practice Address - Fax:727-462-0446
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102624363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9102624OtherLICENSE #
FL593532006OtherTIN
FLK7622Medicare ID - Type UnspecifiedGROUP#
FL593532006OtherTIN