Provider Demographics
NPI:1316249444
Name:DIMARCO, CHRISTAL L (PA)
Entity type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:L
Last Name:DIMARCO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12580 UNIVERSITY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5686
Mailing Address - Country:US
Mailing Address - Phone:239-274-0005
Mailing Address - Fax:239-274-8185
Practice Address - Street 1:12580 UNIVERSITY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5686
Practice Address - Country:US
Practice Address - Phone:239-274-0005
Practice Address - Fax:239-274-8185
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105665363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant