Provider Demographics
NPI:1073576799
Name:LEVERETT, GUY ERNEST (PA-C)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:ERNEST
Last Name:LEVERETT
Suffix:
Gender:M
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 1:841 SYMPHONY ISLES BLVD
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2714
Mailing Address - Country:US
Mailing Address - Phone:813-641-0377
Mailing Address - Fax:
Practice Address - Street 1:300 RIVERSIDE DR E
Practice Address - Street 2:SUITE 2200
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1008
Practice Address - Country:US
Practice Address - Phone:941-748-3376
Practice Address - Fax:941-748-7562
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA0002464363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0598Medicare ID - Type Unspecified