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General NPI Number Information
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NPI Number | 1053847160
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Entity Type | Individual
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Provider Name | FALLON LANHAM PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/10/2017
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Last Update Date | 09/09/2019
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Provider Practice Location Address
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Address Line | 601 5TH ST S STE 302
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City | SAINT PETERSBURG
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State | FL
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Zip | 33701-4804
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Country | US
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Telephone | 813-505-2377
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Fax | 813-200-3491
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Provider Business Mailing Address
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Address Line | 601 5TH ST S STE 302
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City | SAINT PETERSBURG
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State | FL
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Zip | 33701-4804
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Country | US
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Telephone | 727-767-4176
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Fax | 727-767-4379
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9110340
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License Number State | FL
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