Provider Demographics
NPI:1104417906
Name:KEENAN, CAIRO YASMINE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:CAIRO
Middle Name:YASMINE
Last Name:KEENAN
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 1:901 FAWN AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-4172
Mailing Address - Country:US
Mailing Address - Phone:678-975-1503
Mailing Address - Fax:
Practice Address - Street 1:455 PINELLAS ST STE 320
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3369
Practice Address - Country:US
Practice Address - Phone:727-446-2273
Practice Address - Fax:727-441-4966
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114711363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111447600Medicaid