Provider Demographics
NPI:1346375292
Name:MONTANO, PAMELA H (PA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:H
Last Name:MONTANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10898 BAYMEADOWS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4602
Mailing Address - Country:US
Mailing Address - Phone:904-363-2733
Mailing Address - Fax:904-363-3484
Practice Address - Street 1:10898 BAYMEADOWS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4602
Practice Address - Country:US
Practice Address - Phone:904-363-2733
Practice Address - Fax:904-363-3484
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3995YMedicare PIN