Provider Demographics
NPI:1154381580
Name:GARRIDO, EDUARDO JR (PA-C)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:GARRIDO
Suffix:JR
Gender:M
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 1:818 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5642
Mailing Address - Country:US
Mailing Address - Phone:727-443-7478
Mailing Address - Fax:813-436-5459
Practice Address - Street 1:818 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5642
Practice Address - Country:US
Practice Address - Phone:727-443-7478
Practice Address - Fax:813-436-5459
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103256363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001163200Medicaid
FL1154381580OtherNPI
FL001163200Medicaid