Individual
MICHAEL JAMES FERENTINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
909 N DALE MABRY HWY, TAMPA, FL 33609-1251
(813) 978-9700
Mailing address
13020 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0915
(813) 978-9700
(813) 558-6186
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9107469
FL
363AM0700X
Medical Physician Assistant
Primary
PA9107469
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019828800
—
FL
01
—
Y0L7K
FLORIDA BLUE
FL
Enumeration date
09/16/2013
Last updated
07/17/2019
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