Provider Demographics
NPI:1487743431
Name:WOITA, WARREN (PA-C)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:WOITA
Suffix:
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 1:2501 N ORANGE AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4644
Mailing Address - Country:US
Mailing Address - Phone:407-303-2783
Mailing Address - Fax:407-303-0347
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-303-7283
Practice Address - Fax:407-303-0347
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE561363AS0400X
FLPA9112959363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026072600Medicaid
NE10026072500Medicaid
NE10026072600Medicaid
NE10026072500Medicaid
NE330004250Medicare PIN
NENA1080039Medicare PIN
NENA1079045Medicare PIN
S30443Medicare UPIN