Provider Demographics
NPI:1710057484
Name:PROCH, PAULA S (PA)
Entity Type:Individual
Prefix:MISS
First Name:PAULA
Middle Name:S
Last Name:PROCH
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Gender:F
Credentials:PA
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Mailing Address - Street 1:500 VONDERBURG DR
Mailing Address - Street 2:311W
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5964
Mailing Address - Country:US
Mailing Address - Phone:813-654-2445
Mailing Address - Fax:813-654-9885
Practice Address - Street 1:500 VONDERBURG DR
Practice Address - Street 2:SUITE 311 WEST
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5964
Practice Address - Country:US
Practice Address - Phone:813-654-2445
Practice Address - Fax:813-654-9885
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2013-10-01
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Provider Licenses
StateLicense IDTaxonomies
FLPA9100666363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2793XMedicare PIN