Healthcare Provider Details

I. General information

NPI: 1750333209
Provider Name (Legal Business Name): KENNETH MARSHAL LEMOS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 COMMERCIAL WAY
SPRING HILL FL
34606-3300
US

IV. Provider business mailing address

690 SUDBROOK LN
SPRING HILL FL
34609-2061
US

V. Phone/Fax

Practice location:
  • Phone: 352-688-8116
  • Fax: 352-686-9477
Mailing address:
  • Phone: 352-586-6846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101797
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: