Provider Demographics
NPI:1730548959
Name:DANA WIGHTMAN PAC, PLLC
Entity type:Organization
Organization Name:DANA WIGHTMAN PAC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:908-399-4987
Mailing Address - Street 1:253 NE 2ND ST
Mailing Address - Street 2:APT 1603
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-2292
Mailing Address - Country:US
Mailing Address - Phone:908-399-4987
Mailing Address - Fax:
Practice Address - Street 1:253 NE 2ND ST
Practice Address - Street 2:APT 1603
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-2292
Practice Address - Country:US
Practice Address - Phone:908-399-4987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108751363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty