Provider Demographics
NPI:1699895060
Name:ST. AMOUR, DINA (PA)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:ST. AMOUR
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 1:2233 NW 159TH LN
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2437
Mailing Address - Country:US
Mailing Address - Phone:954-253-4967
Mailing Address - Fax:
Practice Address - Street 1:8301 NW 12TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1838
Practice Address - Country:US
Practice Address - Phone:305-665-4614
Practice Address - Fax:305-667-0239
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100896363A00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services