Provider Demographics
NPI:1558339549
Name:FLORES, JOSE (PA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 MEDICAL PARK DR STE 450
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4681
Mailing Address - Country:US
Mailing Address - Phone:813-972-5420
Mailing Address - Fax:813-977-2021
Practice Address - Street 1:3000 MEDICAL PARK DR STE 450
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4681
Practice Address - Country:US
Practice Address - Phone:813-972-5420
Practice Address - Fax:813-977-2021
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5074ZMedicare ID - Type UnspecifiedMEDICARE
FLQ47661Medicare UPIN