Provider Demographics
NPI:1710977475
Name:TURGEON, DENIS D (PA-C)
Entity Type:Individual
Prefix:
First Name:DENIS
Middle Name:D
Last Name:TURGEON
Suffix:
Gender:M
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 1:4215 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-2206
Mailing Address - Country:US
Mailing Address - Phone:973-826-8080
Mailing Address - Fax:888-972-6480
Practice Address - Street 1:4215 EDGEWATER DRIVE
Practice Address - Street 2:SOUTHEASTERN CLINICAL SERVICES
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804
Practice Address - Country:US
Practice Address - Phone:407-539-2000
Practice Address - Fax:407-398-0050
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA156363A00000X
FLPA9104584363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBI466YOtherMEDICARE PTAN - QSS SCS
FLB1466ZOtherMEDICARE PIN - SCS
FLHF826AOtherMEDICARE GRP - QSS SCS
ME411350099Medicaid
FLB1466ZOtherMEDICARE PIN - SCS
MEAP161001Medicare PIN