Basic Information
| Provider Information | |||||||||
| NPI: | 1063579845 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOYLE | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | ANGELICA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.A.-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RAFFINAN | ||||||||
| OtherFirstName: | MARIA | ||||||||
| OtherMiddleName: | ANGELICA | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | P.A.-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 920 S. MYRTLE AVE | ||||||||
| Address2: | STE#A | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337563918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274620444 | ||||||||
| FaxNumber: | 7274620446 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 S. MYRTLE AVE | ||||||||
| Address2: | STE#A | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337563918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274620444 | ||||||||
| FaxNumber: | 7274620446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 01/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9102624 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | PA9102624 | 01 | FL | LICENSE # | OTHER |