Provider Demographics
NPI:1245850122
Name:IDAHOSA, FINOLIA MARIE (PA)
Entity type:Individual
Prefix:
First Name:FINOLIA
Middle Name:MARIE
Last Name:IDAHOSA
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 1:312 E VENICE AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-4670
Mailing Address - Country:US
Mailing Address - Phone:917-385-6081
Mailing Address - Fax:
Practice Address - Street 1:312 E VENICE AVE STE 108
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4670
Practice Address - Country:US
Practice Address - Phone:917-385-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR492-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant