Provider Demographics
NPI:1083354575
Name:DALSANIA, NICOLE S (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:S
Last Name:DALSANIA
Suffix:
Gender:F
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 1:5741 BEE RIDGE RD STE 550
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5080
Mailing Address - Country:US
Mailing Address - Phone:941-361-1100
Mailing Address - Fax:941-361-1103
Practice Address - Street 1:5741 BEE RIDGE RD STE 550
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5080
Practice Address - Country:US
Practice Address - Phone:941-361-1100
Practice Address - Fax:941-361-1103
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115667363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical