Provider Demographics
NPI:1598967986
Name:MAURIZIO, MAURI BETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MAURI
Middle Name:BETH
Last Name:MAURIZIO
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:4919 MEMORIAL HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7516
Mailing Address - Country:US
Mailing Address - Phone:813-333-1512
Mailing Address - Fax:813-333-1561
Practice Address - Street 1:1022 MAIN ST STE R
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5225
Practice Address - Country:US
Practice Address - Phone:727-734-6710
Practice Address - Fax:727-734-6712
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2022-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9110823363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111078300Medicaid