Provider Demographics
NPI:1396176103
Name:PA RESOURCES, INC.
Entity type:Organization
Organization Name:PA RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GODDING
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:727-485-8900
Mailing Address - Street 1:27032 HOLLYBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7434
Mailing Address - Country:US
Mailing Address - Phone:813-345-4444
Mailing Address - Fax:813-333-0445
Practice Address - Street 1:27032 HOLLYBROOK TRL
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7434
Practice Address - Country:US
Practice Address - Phone:813-345-4444
Practice Address - Fax:813-333-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3323363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty