Provider Demographics
NPI:1164672721
Name:BAUTE, LESLEE E (PA)
Entity Type:Individual
Prefix:
First Name:LESLEE
Middle Name:E
Last Name:BAUTE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 SUN CITY CENTER BLVD
Mailing Address - Street 2:UNIT 102
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-5208
Mailing Address - Country:US
Mailing Address - Phone:813-634-1455
Mailing Address - Fax:813-642-8355
Practice Address - Street 1:4002 SUN CITY CENTER BLVD
Practice Address - Street 2:UNIT 102
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5208
Practice Address - Country:US
Practice Address - Phone:813-634-1455
Practice Address - Fax:813-642-8355
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9104766363AS0400X
FLPA9104766207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical