Provider Demographics
NPI:1649460056
Name:CALDERON, MYRNA HAYDEE (PA-C)
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:HAYDEE
Last Name:CALDERON
Suffix:
Gender:F
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 1:13601 NW 19TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-5353
Mailing Address - Country:US
Mailing Address - Phone:305-731-9437
Mailing Address - Fax:
Practice Address - Street 1:7019 NW 11TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3145
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:352-379-4082
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103572363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical