Provider Demographics
NPI:1992770424
Name:TATE-SOLOMON, DANA (PA-C)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:TATE-SOLOMON
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 1:2400 STATE ROAD 415
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6012
Mailing Address - Country:US
Mailing Address - Phone:407-322-8645
Mailing Address - Fax:407-330-5074
Practice Address - Street 1:5449 S SEMORAN BLVD
Practice Address - Street 2:SUITE 14
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1722
Practice Address - Country:US
Practice Address - Phone:407-322-8645
Practice Address - Fax:407-322-8725
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101341363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL682190100Medicaid
FL01115657OtherAMERIGROUP
FL206129OtherWELLCARE
FL01115657OtherAMERIGROUP
FL682190100Medicaid