Provider Demographics
NPI:1972870384
Name:MENCO, MILTON M (PA-C)
Entity type:Individual
Prefix:MR
First Name:MILTON
Middle Name:M
Last Name:MENCO
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 1:6985 WALLACE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5238
Mailing Address - Country:US
Mailing Address - Phone:407-505-4445
Mailing Address - Fax:407-633-3833
Practice Address - Street 1:6985 WALLACE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5238
Practice Address - Country:US
Practice Address - Phone:561-866-3345
Practice Address - Fax:407-633-3833
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105759363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant