Provider Demographics
NPI:1831371004
Name:BUCCI, CHARLES M (PA-C)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:BUCCI
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 1:1306 NE 7TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-3726
Mailing Address - Country:US
Mailing Address - Phone:352-317-0788
Mailing Address - Fax:
Practice Address - Street 1:1306 NE 7TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-3726
Practice Address - Country:US
Practice Address - Phone:352-317-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2123363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292974100Medicaid
FL292974100Medicaid
045052Medicare PIN
E2419ZMedicare PIN