Provider Demographics
NPI:1780696815
Name:MUSINGO, ANTHONY JOHN (PA-C)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOHN
Last Name:MUSINGO
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 1:5068 ANNUNCIATION CIR UNIT 111
Mailing Address - Street 2:
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-9668
Mailing Address - Country:US
Mailing Address - Phone:239-867-4395
Mailing Address - Fax:239-217-3662
Practice Address - Street 1:5068 ANNUNCIATION CIR
Practice Address - Street 2:111
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-9667
Practice Address - Country:US
Practice Address - Phone:239-867-4395
Practice Address - Fax:239-217-3662
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108787363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
092000FEMMedicare ID - Type Unspecified
P21692Medicare UPIN