Individual
MR. DEMITTRE ANDRE ANTHONY SORENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
740 CONCOURSE PKWY S STE 200, MAITLAND, FL 32751-8101
(407) 644-4014
Mailing address
4371 VERONICA S SHOEMAKER BLVD, FORT MYERS, FL 33916-2216
(239) 274-8200
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9114808
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111483000
—
FL
Enumeration date
06/28/2021
Last updated
09/06/2022
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