Provider Demographics
NPI:1164569125
Name:ALMANZAR, JOSE M (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:ALMANZAR
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 1:3164 PALM BEACH BLVD STE 104-D
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-1579
Mailing Address - Country:US
Mailing Address - Phone:239-590-8399
Mailing Address - Fax:239-264-4982
Practice Address - Street 1:3164 PALM BEACH BLVD STE 104-D
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-1579
Practice Address - Country:US
Practice Address - Phone:239-590-8399
Practice Address - Fax:239-264-4982
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3284363AM0700X, 363AS0400X
FLPA3284363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292748900Medicaid
FLE5630XMedicare PIN