Provider Demographics
NPI:1801859277
Name:AMMARI, MUNIR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MUNIR
Middle Name:
Last Name:AMMARI
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 1:461 W OAK ST STE A
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-6624
Mailing Address - Country:US
Mailing Address - Phone:407-846-8600
Mailing Address - Fax:727-568-6011
Practice Address - Street 1:461 W OAK ST STE A
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-6624
Practice Address - Country:US
Practice Address - Phone:407-957-0090
Practice Address - Fax:407-957-1113
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102088400Medicaid
FL292329700Medicaid