Provider Demographics
NPI:1902430259
Name:ARDILA, PAULA ANDREA (PA-C)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:ANDREA
Last Name:ARDILA
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 1:410 CELEBRATION PLACE
Mailing Address - Street 2:STE 208
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5434
Mailing Address - Country:US
Mailing Address - Phone:877-800-0239
Mailing Address - Fax:407-566-2499
Practice Address - Street 1:410 CELEBRATION PLACE
Practice Address - Street 2:STE 208
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5434
Practice Address - Country:US
Practice Address - Phone:877-800-0239
Practice Address - Fax:407-566-2499
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112892363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical