Individual
TYLER STEPHANIE PASSALACQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
950 GLADES RD STE 4A, BOCA RATON, FL 33431-6401
(561) 391-8086
(954) 418-1698
Mailing address
4855 W HILLSBORO BLVD STE B-2, COCONUT CREEK, FL 33073
(954) 418-1683
(954) 418-1698
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9113012
FL
Other
Enumeration date
05/01/2020
Last updated
02/04/2022
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