Provider Demographics
NPI:1275685158
Name:EASTERLING, ADRIAN JAMES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:JAMES
Last Name:EASTERLING
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 1:805 E COUNTY ROAD 466
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-5615
Mailing Address - Country:US
Mailing Address - Phone:352-674-9218
Mailing Address - Fax:352-259-6069
Practice Address - Street 1:805 E COUNTY ROAD 466
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-5615
Practice Address - Country:US
Practice Address - Phone:352-674-9218
Practice Address - Fax:352-259-6069
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104065363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292743800Medicaid
FL292743800Medicaid
FLAE826WMedicare PIN