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General NPI Number Information
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NPI Number | 1063417889
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Entity Type | Individual
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Provider Name | LAKEISHA L PORTER PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13020 N TELECOM PKWY
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City | TEMPLE TERRACE
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State | FL
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Zip | 33637-0925
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Country | US
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Telephone | 813-978-9700
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Fax | 813-972-5055
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Provider Business Mailing Address
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Address Line | 5802 N 30TH ST
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City | TAMPA
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State | FL
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Zip | 33610-1469
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Country | US
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Telephone | 813-235-5200
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Fax | 813-236-5222
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9102987
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License Number State | FL
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