Provider Demographics
NPI:1407270788
Name:DAMATO, MICHAEL J JR (APRN,FNP-C,PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DAMATO
Suffix:JR
Gender:M
Credentials:APRN,FNP-C,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 SR 64 EAST
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5522
Mailing Address - Country:US
Mailing Address - Phone:941-896-5845
Mailing Address - Fax:941-896-3082
Practice Address - Street 1:5008 SR 64 EAST
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208
Practice Address - Country:US
Practice Address - Phone:941-896-5845
Practice Address - Fax:941-896-3082
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9256567163WE0003X
FLAPRN9256567363LF0000X, 363L00000X
FLF0214044363LF0000X
FL9256567363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010870500Medicaid