Provider Demographics
NPI:1962683813
Name:PHILLIPS, FRANCINE MARIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:FRANCINE
Middle Name:MARIE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 VIA BELLA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-5429
Mailing Address - Country:US
Mailing Address - Phone:813-948-1498
Mailing Address - Fax:813-355-5040
Practice Address - Street 1:2100 VIA BELLA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-5429
Practice Address - Country:US
Practice Address - Phone:813-948-1498
Practice Address - Fax:813-355-5040
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9103566363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK270YMedicare PIN