Provider Demographics
NPI:1598483935
Name:CANALE, MARISA J (PA)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:J
Last Name:CANALE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W HYDE PARK PL APT 205
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2343
Mailing Address - Country:US
Mailing Address - Phone:716-544-6177
Mailing Address - Fax:
Practice Address - Street 1:204 W HYDE PARK PL APT 205
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2343
Practice Address - Country:US
Practice Address - Phone:716-544-6177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty