Provider Demographics
NPI:1891103149
Name:PERRY, ARIEL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ARIEL
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ARIEL
Other - Middle Name:
Other - Last Name:BROMLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8700 FRONT BEACH RD
Mailing Address - Street 2:UNIT 2307
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-4277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 E 6TH ST
Practice Address - Street 2:SUITE 504
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3661
Practice Address - Country:US
Practice Address - Phone:850-769-0329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108048363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant