Provider Demographics
NPI:1609822196
Name:INGALLINERA, JOSEPH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:INGALLINERA
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 1:1217 S EAST AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2344
Mailing Address - Country:US
Mailing Address - Phone:941-366-4440
Mailing Address - Fax:941-366-2049
Practice Address - Street 1:1217 S EAST AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2344
Practice Address - Country:US
Practice Address - Phone:941-366-4440
Practice Address - Fax:941-366-2049
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103702363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292447100Medicaid
FLQ72815Medicare UPIN
FLU8504XMedicare PIN
FL292447100Medicaid