Provider Demographics
NPI:1689895963
Name:NAZARIO, MARGARET ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:ANN
Last Name:NAZARIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MARGARET
Other - Middle Name:ANN
Other - Last Name:DE LOS SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:625 6TH AVE S STE 405
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4665
Mailing Address - Country:US
Mailing Address - Phone:727-498-8994
Mailing Address - Fax:727-498-8982
Practice Address - Street 1:625 6TH AVE S STE 405
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4665
Practice Address - Country:US
Practice Address - Phone:727-498-8994
Practice Address - Fax:727-498-8982
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103232363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000411800Medicaid