Provider Demographics
NPI:1164666962
Name:GILES, CLARISSA ISABELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:ISABELLE
Last Name:GILES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CLARISSA
Other - Middle Name:ISABELLE
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:107 NW 133RD TER
Mailing Address - Street 2:APT 307
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-7684
Mailing Address - Country:US
Mailing Address - Phone:954-793-9301
Mailing Address - Fax:
Practice Address - Street 1:5353 W ATLANTIC AVE
Practice Address - Street 2:SUITE 400-A
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8174
Practice Address - Country:US
Practice Address - Phone:561-638-0598
Practice Address - Fax:561-381-4581
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104959363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical