Provider Demographics
NPI:1164478053
Name:LEY, JOHN L (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:LEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1340 TUSKAWILLA RD
Mailing Address - Street 2:SUITE 101-105
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5030
Mailing Address - Country:US
Mailing Address - Phone:407-699-1160
Mailing Address - Fax:407-699-7861
Practice Address - Street 1:1340 TUSKAWILLA RD
Practice Address - Street 2:SUITE 101-105
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5030
Practice Address - Country:US
Practice Address - Phone:407-699-1160
Practice Address - Fax:407-699-7861
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA2591363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S67763Medicare UPIN