Provider Demographics
NPI:1891895207
Name:MCDONALD-DALLESSIO, ELIZABETH A (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:MCDONALD-DALLESSIO
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3550 BUSCHWOOD PARK DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4461
Mailing Address - Country:US
Mailing Address - Phone:813-936-5000
Mailing Address - Fax:813-936-5001
Practice Address - Street 1:3550 BUSCHWOOD PARK DR
Practice Address - Street 2:SUITE 350
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4461
Practice Address - Country:US
Practice Address - Phone:813-936-5000
Practice Address - Fax:813-936-5001
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2010-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9101492363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2913372 00Medicaid
FLE4910YMedicare PIN
FLP19787Medicare UPIN