Provider Demographics
NPI:1063496156
Name:DONATO, JAMES C (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:DONATO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1219 S EAST AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2340
Mailing Address - Country:US
Mailing Address - Phone:855-433-2010
Mailing Address - Fax:
Practice Address - Street 1:1700 S TAMIAMI TR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:941-917-8507
Practice Address - Fax:855-433-2010
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101279363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P12049Medicare UPIN
P12049Medicare UPIN
FLE4482YMedicare ID - Type Unspecified