Provider Demographics
NPI:1922750199
Name:GJINOLLARI, BLEDAR (PAC)
Entity Type:Individual
Prefix:MR
First Name:BLEDAR
Middle Name:
Last Name:GJINOLLARI
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:778-563-7748
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:3369 PINE RIDGE RD UNIT 203
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-3932
Practice Address - Country:US
Practice Address - Phone:239-631-2662
Practice Address - Fax:239-631-8597
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9115420363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant