Provider Demographics
NPI:1043243298
Name:AVENDANO, ALONSO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ALONSO
Middle Name:
Last Name:AVENDANO
Suffix:
Gender:M
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 1:1500 SE 17TH ST STE 600
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4630
Mailing Address - Country:US
Mailing Address - Phone:352-732-8955
Mailing Address - Fax:352-732-7999
Practice Address - Street 1:1500 SE 17TH ST STE 600
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4630
Practice Address - Country:US
Practice Address - Phone:352-732-8955
Practice Address - Fax:352-732-7999
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103784363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPAT9103784OtherLICENSE