Provider Demographics
NPI:1356560833
Name:PORRAS, ANABEL (PA)
Entity type:Individual
Prefix:
First Name:ANABEL
Middle Name:
Last Name:PORRAS
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 1:109 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5203
Mailing Address - Country:US
Mailing Address - Phone:813-654-2544
Mailing Address - Fax:813-353-4391
Practice Address - Street 1:109 MARGARET ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5203
Practice Address - Country:US
Practice Address - Phone:813-654-2544
Practice Address - Fax:813-353-4391
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9103368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2930731Medicaid