Provider Demographics
NPI:1326070533
Name:D'AMBRA, PAULA (PA-C)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:D'AMBRA
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 1:399 9TH ST N
Mailing Address - Street 2:#300
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5820
Mailing Address - Country:US
Mailing Address - Phone:239-624-4200
Mailing Address - Fax:239-624-4201
Practice Address - Street 1:399 9TH ST N
Practice Address - Street 2:#300
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5820
Practice Address - Country:US
Practice Address - Phone:239-624-4200
Practice Address - Fax:239-624-4201
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100922363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY04JBOtherBCBS
FLE3420XOtherMEDICARE
FL010621400Medicaid
FLY04JBOtherBCBS
S94703Medicare UPIN