Individual
PENN L MATTOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4215 EDGEWATER DR, ORLANDO, FL 32804-2206
(407) 539-2000
(407) 398-0050
Mailing address
1955 1ST AVENUE NORTH, SUITE 101, SAINT PETERSBURG, FL 33713-8907
(727) 822-3500
(727) 822-3228
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA3280
FL
363AS0400X
Surgical Physician Assistant
Primary
PA380
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2920905 00
—
FL
01
—
E4034Y
FL MCARE - QSS SOUTHEAST CLINICAL SERVICES
FL
Enumeration date
01/10/2006
Last updated
03/17/2018
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