Provider Demographics
NPI:1992065478
Name:FERRER, NOEL GUSMAN (PA-C)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:GUSMAN
Last Name:FERRER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NOEL
Other - Middle Name:
Other - Last Name:GUSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:151 SOUTHHALL LN
Mailing Address - Street 2:STE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:1825 OLD ALABAMA RD STE 201
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2258
Practice Address - Country:US
Practice Address - Phone:770-393-9000
Practice Address - Fax:770-393-9006
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7804363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1102950OtherNCCPA