Provider Demographics
NPI:1922282672
Name:PERDICARO, DANIEL ALEJANDRO (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALEJANDRO
Last Name:PERDICARO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4790 BARKLEY CIR # A
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7543
Mailing Address - Country:US
Mailing Address - Phone:239-275-8882
Mailing Address - Fax:239-939-1330
Practice Address - Street 1:4790 BARKLEY CIR # A
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7543
Practice Address - Country:US
Practice Address - Phone:239-275-8882
Practice Address - Fax:239-939-1330
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant