Provider Demographics
NPI:1821074626
Name:CIUFO, PHILIP J JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:J
Last Name:CIUFO
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 616788
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-6788
Mailing Address - Country:US
Mailing Address - Phone:407-447-7105
Mailing Address - Fax:407-770-0594
Practice Address - Street 1:1049 W ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-3482
Practice Address - Country:US
Practice Address - Phone:407-884-2952
Practice Address - Fax:407-884-9352
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA1966363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL092210000Medicaid
FLS50348Medicare UPIN
FLE0236XMedicare ID - Type Unspecified