Provider Demographics
NPI:1770728685
Name:PAQUIN, ROBERT T (PA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:T
Last Name:PAQUIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1003 DEL PRADO BLVD S STE 101
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3601
Mailing Address - Country:US
Mailing Address - Phone:239-574-4600
Mailing Address - Fax:239-574-2621
Practice Address - Street 1:1003 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3601
Practice Address - Country:US
Practice Address - Phone:239-574-4600
Practice Address - Fax:239-574-2621
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107234363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL279500OtherMEDICARE GROUP
IL279500010Medicare PIN
IL0407950001Medicare NSC