Provider Demographics
NPI:1215987029
Name:BOTERO, CLAUDIA (PA)
Entity type:Individual
Prefix:MS
First Name:CLAUDIA
Middle Name:
Last Name:BOTERO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4662
Mailing Address - Country:US
Mailing Address - Phone:727-553-7100
Mailing Address - Fax:727-553-7198
Practice Address - Street 1:625 6TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4662
Practice Address - Country:US
Practice Address - Phone:727-553-7100
Practice Address - Fax:727-553-7198
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100963363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290646500Medicaid
P302140001Medicare UPIN
FLE5430ZMedicare ID - Type Unspecified