Provider Demographics
NPI:1184026015
Name:ADKINS, CALLY O (PA-C)
Entity Type:Individual
Prefix:
First Name:CALLY
Middle Name:O
Last Name:ADKINS
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 1:1846 JASMINE DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6005
Mailing Address - Country:US
Mailing Address - Phone:407-492-6483
Mailing Address - Fax:
Practice Address - Street 1:5573 MARQUESAS CIR UNIT B
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3332
Practice Address - Country:US
Practice Address - Phone:407-492-6483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111191363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2040627Medicaid
WAG8935990Medicare PIN
WAG8935991Medicare PIN
WAG8935988Medicare PIN
WAG8935989Medicare PIN