Provider Demographics
NPI:1033973946
Name:LEBEAU, CATHERINE (PA-C)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:LEBEAU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 15TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-7505
Mailing Address - Country:US
Mailing Address - Phone:208-360-4274
Mailing Address - Fax:
Practice Address - Street 1:699 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-3705
Practice Address - Country:US
Practice Address - Phone:941-477-4007
Practice Address - Fax:877-239-7174
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9118377363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant