Provider Demographics
NPI:1518986074
Name:ARCHULETA PINTOR, MARIA DEL CARMEN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:DEL CARMEN
Last Name:ARCHULETA PINTOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2235
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32067-2235
Mailing Address - Country:US
Mailing Address - Phone:706-573-8273
Mailing Address - Fax:904-298-1922
Practice Address - Street 1:2021 KINGSLEY AVE STE 101
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5128
Practice Address - Country:US
Practice Address - Phone:904-298-2113
Practice Address - Fax:904-298-1922
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103744363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAE209WMedicare PIN
FLAE209ZMedicare PIN