Provider Demographics
NPI:1093751760
Name:POLITO, DONNA SIMONEAU (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:SIMONEAU
Last Name:POLITO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5922 CATTLEMEN LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6204
Mailing Address - Country:US
Mailing Address - Phone:941-371-9773
Mailing Address - Fax:941-556-0341
Practice Address - Street 1:5922 CATTLEMEN LN
Practice Address - Street 2:SUITE 201
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6204
Practice Address - Country:US
Practice Address - Phone:941-371-9773
Practice Address - Fax:941-556-0341
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102426363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292322000Medicaid
FL292322000Medicaid
FLU3496ZMedicare PIN