Provider Demographics
NPI:1588600282
Name:CRONYN, MICHAEL J (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:CRONYN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2415 N ORANGE AVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5505
Mailing Address - Country:US
Mailing Address - Phone:407-303-2580
Mailing Address - Fax:407-303-2801
Practice Address - Street 1:2415 N ORANGE AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5505
Practice Address - Country:US
Practice Address - Phone:407-303-2508
Practice Address - Fax:407-303-2801
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA1907363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290288500Medicaid
970027350OtherRAILROAD MEDICARE
FLE1636YMedicare PIN
970027350OtherRAILROAD MEDICARE