Provider Demographics
NPI:1649288275
Name:RAND PRICONE, CARA (PA)
Entity type:Individual
Prefix:MRS
First Name:CARA
Middle Name:
Last Name:RAND PRICONE
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 1:6725 CEDAR RIDGE DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7515
Mailing Address - Country:US
Mailing Address - Phone:813-788-7662
Mailing Address - Fax:813-788-7464
Practice Address - Street 1:6725 CEDAR RIDGE DR
Practice Address - Street 2:SUITE 4
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-7515
Practice Address - Country:US
Practice Address - Phone:813-788-7662
Practice Address - Fax:813-788-7464
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2749363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS59893Medicare UPIN
FLE1015ZMedicare ID - Type Unspecified