Provider Demographics
NPI:1679250096
Name:MINNICK, PAULA (CME)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:MINNICK
Suffix:
Gender:F
Credentials:CME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2673 CYPRESS BEND DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3811
Mailing Address - Country:US
Mailing Address - Phone:610-639-5558
Mailing Address - Fax:
Practice Address - Street 1:25973 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-2013
Practice Address - Country:US
Practice Address - Phone:727-266-5693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEO4534246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other