Provider Demographics
NPI:1841428653
Name:TINDAL, MARIA VICTORIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:VICTORIA
Last Name:TINDAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:VICTORIA
Other - Last Name:KYLLONEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7628 CHARLESTON ST
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34201-2096
Mailing Address - Country:US
Mailing Address - Phone:941-323-9228
Mailing Address - Fax:
Practice Address - Street 1:7628 CHARLESTON ST
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201-2096
Practice Address - Country:US
Practice Address - Phone:941-323-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105045363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCI473YMedicare PIN