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NPI Code Detail

MEDICARE: MRS. ERIN ANNE IKENBERRY PA-C

MEDICARE: MRS. ERIN ANNE IKENBERRY PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant011877NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457550014
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ERIN ANNE IKENBERRY PA-C
Provider Business Mailing Address
First Line : 9988 LAKE SEMINOLE DR W
Second Line :
City : LARGO
State : FL
Zip : 33773-4551
Country : US
Telephone Number : 813-635-6106
Fax Number :
Provider Business Practice Location Address
First Line : 4004 N RIVERSIDE DR
Second Line :
City : TAMPA
State : FL
Zip : 33603-3212
Country : US
Telephone Number : 813-296-8318
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2007
Last Update Date : 12/18/2021

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