Provider Demographics
NPI:1720335904
Name:KOBER, TERRY DANIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:DANIEL
Last Name:KOBER
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 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:813-689-7571
Mailing Address - Fax:813-654-8129
Practice Address - Street 1:11260 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-2140
Practice Address - Country:US
Practice Address - Phone:813-689-7571
Practice Address - Fax:813-654-8129
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1440363A00000X
FLPA9105264363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK099660OtherMEDICARE PTAN
FLPA9105264OtherSTATE LICENSE
FL013091300Medicaid
KY1440OtherSTATE LICENSE