Provider Demographics
NPI:1093445678
Name:BAEZ, ALYSSA CHRISTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:CHRISTINE
Last Name:BAEZ
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 1:38135 MARKET SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-888-8887
Mailing Address - Fax:
Practice Address - Street 1:6101 WEBB RD STE 106
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2859
Practice Address - Country:US
Practice Address - Phone:813-888-8887
Practice Address - Fax:813-377-1701
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116506363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant