Basic Information
| Provider Information | |||||||||
| NPI: | 1215333943 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PINO | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | DONATO | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3271 BANYON HOLLOW LOOP | ||||||||
| Address2: | |||||||||
| City: | NORTH FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339037157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2398222406 | ||||||||
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| Practice Location | |||||||||
| Address1: | 632 DEL PRADO BLVD N | ||||||||
| Address2: | |||||||||
| City: | CAPE CORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339092278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2398297102 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2014 | ||||||||
| LastUpdateDate: | 09/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9108370 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.