Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1861486789 Deactivated / Inactive NPI Male Practitioner

Daniel N. Park , MPAS, PA-C

Physician Assistant - Medical • Macdill Afb, FL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Daniel Park has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 07, 2005
NPI Deactivation Date November 16, 2020
Total Practice Duration ~15 Years of Practice (2005 – 2020)

Professional Overview & Biography Verified Profile Summary

Daniel Park, MPAS, PA-C was a registered Physician Assistant - Medical practicing in Macdill Afb, FL. Throughout an active medical career spanning 15 years, Daniel Park provided care at the practice location at USSOCOM CLINIC until profile deactivation on 2020-11-16.

Practice Location & Contact Primary Location

Practice Address

Ussocom Clinic
8415 Bayshore Blvd

Macdill Afb, FL 336211607

Telephone 8138279870
Fax 8138284436

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant - Medical in Macdill Afb, FL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 15.5 Yrs
Regional Practice Density
3 Specialists

Practicing in Macdill Afb, FL (2836 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Physician Assistant - Medical Primary Specialty

NUCC Taxonomy Code: 363AM0700X

State License FL PA 9102370

Definition to come...

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

10 Associated Practitioners
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Doctor of Philosophy (Ph.D.)

April Critelli , PA-C

Physician Assistant

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Physician Assistant (Certified)

Ashley Vanegas

Physician Assistant

NPI 1538753504
Dr. Graeme Bicknell , PhD

Social Worker - Clinical

NPI 1558378273

Doctor of Philosophy (Ph.D.)

Cary Pilet , ARNP

Nurse Practitioner - Family

NPI 1588653968

Advanced Registered Nurse Practitioner

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

9 Historical Events
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NPI Profile Deactivated November 16, 2020

Record deactivated on November 16, 2020

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Updated Practice Location April 10, 2018

Registered at USSOCOM CLINIC, 3250 ZEMKE AVE, MACDILL AFB, FL 33621 (Tel: 8138279871)

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Updated Business Mailing Address April 10, 2018

Registered at 8722 15TH ST N, SAINT PETERSBURG, FL 337022946 (Tel: 8135456736)

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at USSOCOM CLINIC, 8415 BAYSHORE BLVD, MACDILL AFB, FL 336211607 (Tel: 8138279870)

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Updated Business Mailing Address July 08, 2007

Registered at 4717 JENNINGS BAY CT, TAMPA, FL 336113237 (Tel: 8138397204)

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Provider Name / Credentials Updated July 08, 2007

Recorded as DANIEL PARK, MPAS, PA-C

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Physician Assistant (License #PA 9102370 in FL)

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Initial NPI Registration & Enumeration September 07, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1861486789
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 07, 2005
Last Update: July 08, 2007
Deactivation Date: November 16, 2020

Mailing Address

4717 Jennings Bay Ct

Tampa, FL 336113237

Phone: 8138397204

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.