Individual provider · NPI-1

Penny Marie Dilorenzo, CSFA

Physician Assistant, Surgical · Waycross, GA

NPI number1952992547
StatusActive
Last updated in NPPESJan 4, 2022

Details

NPI
1952992547
Entity type
Individual (NPI-1)
Name
Penny Marie Dilorenzo
Credential
CSFA
Sex
Female
Sole proprietor
No
Enumeration date
Jan 27, 2021
Certification date
Feb 4, 2021
Last updated
Jan 4, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363AS0400X Physician Assistant, Surgical––Yes
246ZC0007X Specialist/Technologist, Other, Surgical Assistant––

Practice location

694 Saddle Cir
Waycross, GA 31503-7930

Phone 912-337-7789

Mailing address

694 Saddle Cir
Waycross, GA 31503-7930

Phone 912-337-7789

Other practice locations

1900 Tebeau St
Waycross, GA 31501-6357

Phone 912-283-3030

545 Knight Ave
Waycross, GA 31501-3354

Phone 912-490-3668

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