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General NPI Number Information
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NPI Number | 1376966069
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Entity Type | Individual
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Provider Name | LAURA CHAN-LING PA
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Gender | Female
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 3001 W DR MARTIN LUTHER KING JR BLVD
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City | TAMPA
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State | FL
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Zip | 33607-6307
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Country | US
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Telephone | 813-554-8384
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Fax | 813-443-8160
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Provider Business Mailing Address
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Address Line | PO BOX 10744
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City | CLEARWATER
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State | FL
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Zip | 33757-8744
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Country | US
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Telephone | 727-532-0002
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Fax | 727-266-4928
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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 | PA9107717
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License Number State | FL
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