Provider Demographics
NPI:1780962316
Name:MASSARSKY, EVE L (PA-C)
Entity type:Individual
Prefix:MS
First Name:EVE
Middle Name:L
Last Name:MASSARSKY
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 1:5405 PARK ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-1044
Mailing Address - Country:US
Mailing Address - Phone:727-547-8425
Mailing Address - Fax:813-635-2699
Practice Address - Street 1:5405 PARK ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-1044
Practice Address - Country:US
Practice Address - Phone:727-547-8425
Practice Address - Fax:813-635-2699
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106034363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006697900Medicaid
FLF1549XMedicare PIN
FLF1549YMedicare PIN