Provider Demographics
NPI:1407428006
Name:MOLTZ, JOSEPH ALAN (PA-C)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALAN
Last Name:MOLTZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850001, DEPT 8340
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0001
Mailing Address - Country:US
Mailing Address - Phone:813-536-7277
Mailing Address - Fax:855-830-1722
Practice Address - Street 1:320 W FLETCHER AVE STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3400
Practice Address - Country:US
Practice Address - Phone:813-374-9266
Practice Address - Fax:813-374-9267
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114264363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant