Provider Demographics
NPI:1124202734
Name:ROSS, PAMELA (PA-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:ROSS
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 1:3280C S ATLANTIC AVE # 48
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:32118-6247
Mailing Address - Country:US
Mailing Address - Phone:386-341-4070
Mailing Address - Fax:
Practice Address - Street 1:802 DUNLAWTON AVE
Practice Address - Street 2:INSTITUTE FOR WELLBEING SUITE 102
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4931
Practice Address - Country:US
Practice Address - Phone:386-763-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104169363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical