Provider Demographics
NPI:1023288917
Name:VINO, DARA MADELYN (PA)
Entity type:Individual
Prefix:MRS
First Name:DARA
Middle Name:MADELYN
Last Name:VINO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2963
Mailing Address - Country:US
Mailing Address - Phone:407-644-2990
Mailing Address - Fax:
Practice Address - Street 1:156 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2963
Practice Address - Country:US
Practice Address - Phone:407-644-2990
Practice Address - Fax:407-644-4370
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-936363A00000X
COPA-2744363AM0700X
FLPA9113919363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant