Provider Demographics
NPI:1972988467
Name:MINCONE, KARLA MICHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:MICHELLE
Last Name:MINCONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:MICHELLE
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:910 GRAND CRESTA AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6533
Mailing Address - Country:US
Mailing Address - Phone:813-789-9332
Mailing Address - Fax:
Practice Address - Street 1:3040 W CYPRESS ST # 103
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1615
Practice Address - Country:US
Practice Address - Phone:813-789-9332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-25
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108482363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical