Provider Demographics
NPI:1508036419
Name:PIAZZA, ERIC STEPHEN (PA)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:STEPHEN
Last Name:PIAZZA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:311 N CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 580
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2781
Mailing Address - Country:US
Mailing Address - Phone:386-425-5058
Mailing Address - Fax:386-257-5058
Practice Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 505
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5170
Practice Address - Country:US
Practice Address - Phone:386-231-3540
Practice Address - Fax:386-231-3544
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102326363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292012300Medicaid
FLQ32046Medicare UPIN
FLU4040YMedicare PIN