Provider Demographics
NPI:1659636264
Name:CANATA, ANDREA (PA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:CANATA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:CLEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2454 N MCMULLEN BOOTH RD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1353
Mailing Address - Country:US
Mailing Address - Phone:727-796-7705
Mailing Address - Fax:727-796-8764
Practice Address - Street 1:2454 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 601
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1353
Practice Address - Country:US
Practice Address - Phone:727-796-7705
Practice Address - Fax:727-796-8764
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106229363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-3585336OtherFEDERAL TAX IDENTIFICATION NUMBER