Provider Demographics
NPI:1033209754
Name:GENNARA, THOMAS SCOTT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:SCOTT
Last Name:GENNARA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6006 49TH ST N
Mailing Address - Street 2:STE 310
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2148
Mailing Address - Country:US
Mailing Address - Phone:727-490-5040
Mailing Address - Fax:727-490-5045
Practice Address - Street 1:270 S MOON AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5711
Practice Address - Country:US
Practice Address - Phone:813-571-9988
Practice Address - Fax:813-571-9922
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2022-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA1808363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01320498OtherRR MEDICARE
FL009471200Medicaid
FL009471200Medicaid