Provider Demographics
NPI:1104334689
Name:AGUILAR, MANUELA M (PA-C)
Entity type:Individual
Prefix:
First Name:MANUELA
Middle Name:M
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 STATE ROAD 580 STE 202
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3167
Mailing Address - Country:US
Mailing Address - Phone:727-733-6111
Mailing Address - Fax:727-733-6002
Practice Address - Street 1:2655 STATE ROAD 580 STE 202
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3167
Practice Address - Country:US
Practice Address - Phone:727-733-6111
Practice Address - Fax:727-733-6002
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110953363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant