Provider Demographics
NPI:1376106005
Name:CAMMARDELLA, DANIEL A (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:CAMMARDELLA
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 1:6775 CROSSWINDS DR N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5471
Mailing Address - Country:US
Mailing Address - Phone:727-381-8006
Mailing Address - Fax:
Practice Address - Street 1:2191 9TH AVE N STE 220
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7148
Practice Address - Country:US
Practice Address - Phone:727-327-9667
Practice Address - Fax:727-321-1655
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9114693207Q00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine