Provider Demographics
NPI:1245467729
Name:CARDIOVASCULAR AND SURGICAL FIRST ASSISTANTS OF CENTRAL FLORIDA, PA
Entity type:Organization
Organization Name:CARDIOVASCULAR AND SURGICAL FIRST ASSISTANTS OF CENTRAL FLORIDA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:407-701-4253
Mailing Address - Street 1:4584 OLD CARRIAGE TRL
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8473
Mailing Address - Country:US
Mailing Address - Phone:407-491-0114
Mailing Address - Fax:407-679-4343
Practice Address - Street 1:4584 OLD CARRIAGE TRL
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8473
Practice Address - Country:US
Practice Address - Phone:407-491-0114
Practice Address - Fax:407-679-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty