Provider Demographics
NPI:1619908449
Name:PAZZALIA, AMY DENISE (PAC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:DENISE
Last Name:PAZZALIA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:PAZZALIA
Other - Last Name:CHEATWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-273-7832
Mailing Address - Fax:352-265-0525
Practice Address - Street 1:1600 SW ARCHER ROAD
Practice Address - Street 2:BOX 100371
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0371
Practice Address - Country:US
Practice Address - Phone:352-273-7832
Practice Address - Fax:352-265-0525
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100959363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291579100Medicaid
FLU0819YMedicare PIN
P91181Medicare UPIN
FL291579100Medicaid