Provider Demographics
NPI:1457351181
Name:PARRINO, JACK (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:PARRINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5128 N HABANA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-6874
Mailing Address - Country:US
Mailing Address - Phone:813-877-0550
Mailing Address - Fax:813-876-0635
Practice Address - Street 1:5128 N HABANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-6874
Practice Address - Country:US
Practice Address - Phone:813-877-0550
Practice Address - Fax:813-876-0635
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2013-02-18
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
FLME0029092174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065960600Medicaid
FLD53896Medicare UPIN
FL30219Medicare PIN