Provider Demographics
NPI:1508036419
Name:PIAZZA, ERIC STEPHEN (PA)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:STEPHEN
Last Name:PIAZZA
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:311 N CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 580
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2781
Mailing Address - Country:US
Mailing Address - Phone:386-425-5058
Mailing Address - Fax:386-257-5058
Practice Address - Street 1:311 N CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 580
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2781
Practice Address - Country:US
Practice Address - Phone:386-425-5055
Practice Address - Fax:386-257-5058
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2017-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102326363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292012300Medicaid
FLQ32046Medicare UPIN
FLU4040YMedicare PIN