Individual
ANTHONY MENNELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-3003
(352) 392-1161
(352) 392-5078
Mailing address
PO BOX 918025, ORLANDO, FL 32891-8025
(352) 392-1161
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA1544
FL
363AM0700X
Medical Physician Assistant
Primary
PA1544
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002936000
—
FL
Enumeration date
04/27/2006
Last updated
01/10/2011
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