Provider Demographics
NPI:1548213093
Name:HARINARINE, UPENDRA PAUL (PA C)
Entity Type:Individual
Prefix:
First Name:UPENDRA
Middle Name:PAUL
Last Name:HARINARINE
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 1:104 PARK PLACE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-6866
Mailing Address - Country:US
Mailing Address - Phone:407-841-1200
Mailing Address - Fax:407-649-8342
Practice Address - Street 1:104 PARK PLACE BLVD STE A
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-6866
Practice Address - Country:US
Practice Address - Phone:407-841-1200
Practice Address - Fax:407-649-8342
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101462363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1548213093OtherNPI
FL291759900Medicaid
FLP79961Medicare UPIN
FL291759900Medicaid