Provider Demographics
NPI:1497172498
Name:CROTEAU, SEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:CROTEAU
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 1:1528 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3648
Mailing Address - Country:US
Mailing Address - Phone:727-446-5633
Mailing Address - Fax:727-447-6312
Practice Address - Street 1:711 S DALE MABRY HWY STE 303
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4400
Practice Address - Country:US
Practice Address - Phone:813-548-7890
Practice Address - Fax:813-605-6157
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107777363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116618600Medicaid