Provider Demographics
NPI:1962544452
Name:PAGLINO, JACQUELINE (PA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:PAGLINO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:SIMONETTA-PAGLINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1921 WALDEMERE ST STE 401
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2941
Mailing Address - Country:US
Mailing Address - Phone:941-262-1400
Mailing Address - Fax:
Practice Address - Street 1:1921 WALDEMERE ST STE 401
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2941
Practice Address - Country:US
Practice Address - Phone:941-262-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006372363AS0400X
FLPA9118285363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical