Provider Demographics
NPI:1619355302
Name:PHYSICIAN ASSISTANT SERVICES DBA CITRA FAMILY HEALTH
Entity Type:Organization
Organization Name:PHYSICIAN ASSISTANT SERVICES DBA CITRA FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-286-6981
Mailing Address - Street 1:5939 SE 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-6127
Mailing Address - Country:US
Mailing Address - Phone:352-286-6981
Mailing Address - Fax:352-622-3025
Practice Address - Street 1:17805 N US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:CITRA
Practice Address - State:FL
Practice Address - Zip Code:32113-2459
Practice Address - Country:US
Practice Address - Phone:352-595-7777
Practice Address - Fax:352-595-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2401261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS58197OtherUPIN