Provider Demographics
NPI:1891220133
Name:TOLEDO, MIERLYN YVONNE (PA-C)
Entity type:Individual
Prefix:
First Name:MIERLYN
Middle Name:YVONNE
Last Name:TOLEDO
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:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:392-748-2002
Mailing Address - Fax:
Practice Address - Street 1:681 4TH AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5729
Practice Address - Country:US
Practice Address - Phone:239-434-2622
Practice Address - Fax:239-434-6876
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9110314363A00000X
FLPA9110314363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant