Provider Demographics
NPI:1851853154
Name:WROTSLAVSKY, MICHAL (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAL
Middle Name:
Last Name:WROTSLAVSKY
Suffix:
Gender:F
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 1:1301 E BROWARD BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2111
Mailing Address - Country:US
Mailing Address - Phone:954-983-4190
Mailing Address - Fax:
Practice Address - Street 1:4425 PONCE DE LEON BLVD STE 110
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1842
Practice Address - Country:US
Practice Address - Phone:305-446-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X, 390200000X
FLPA9113608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program