Provider Demographics
NPI:1629264676
Name:PILZ, DANA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:PILZ
Suffix:
Gender:F
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 1:401 INTERSTATE BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8996
Mailing Address - Country:US
Mailing Address - Phone:941-312-5027
Mailing Address - Fax:941-554-8587
Practice Address - Street 1:5301 4TH AVENUE CIR E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5623
Practice Address - Country:US
Practice Address - Phone:941-761-2900
Practice Address - Fax:941-795-1400
Is Sole Proprietor?:No
Enumeration Date:2007-09-23
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113423363A00000X
VA0110002207363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0149693Medicaid