Provider Demographics
NPI:1134782501
Name:HERRERA ALZATE, GERMAN SANTIAGO (PA-C)
Entity type:Individual
Prefix:
First Name:GERMAN
Middle Name:SANTIAGO
Last Name:HERRERA ALZATE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 NE 54TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785
Mailing Address - Country:US
Mailing Address - Phone:352-689-4000
Mailing Address - Fax:
Practice Address - Street 1:846 NE 54TH TERRACE
Practice Address - Street 2:
Practice Address - City:WIDLWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785
Practice Address - Country:US
Practice Address - Phone:352-689-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-20
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant