Individual
DEREK DOUGLAS MAGNUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7550 N DALE MABRY HWY, TAMPA, FL 33614-3226
(813) 885-4706
(813) 885-9463
Mailing address
7550 N DALE MABRY HWY, TAMPA, FL 33614-3226
(813) 885-4706
(813) 885-9463
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9101889
FL
363AM0700X
Medical Physician Assistant
Primary
PA9101889
FL
Other
Enumeration date
10/10/2006
Last updated
01/22/2021
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