Individual
MONTANA C PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1950 ARLINGTON ST STE 111, SARASOTA, FL 34239-3508
(941) 921-2600
(941) 925-8672
Mailing address
19701 GULF BLVD UNIT 401, INDIAN SHORES, FL 33785-2386
(727) 743-2276
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA9115470
FLORIDA LICENSE
FL
Enumeration date
03/01/2022
Last updated
06/08/2022
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