Provider Demographics
NPI:1992174239
Name:DVOYASHKINA, KAMILYA NARIMANOVNA (PA)
Entity type:Individual
Prefix:
First Name:KAMILYA
Middle Name:NARIMANOVNA
Last Name:DVOYASHKINA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:26844 TANIC DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-4616
Mailing Address - Country:US
Mailing Address - Phone:813-779-6303
Mailing Address - Fax:888-977-1998
Practice Address - Street 1:26844 TANIC DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544
Practice Address - Country:US
Practice Address - Phone:813-779-6303
Practice Address - Fax:888-977-1998
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9108923363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant