Provider Demographics
NPI:1285660886
Name:IVES, BILLY E JR (PA-C)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:E
Last Name:IVES
Suffix:JR
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:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:1921 WALDEMERE ST STE 504
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2941
Practice Address - Country:US
Practice Address - Phone:941-917-8525
Practice Address - Fax:941-917-8526
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC146165363A00000X
FLPA9102865363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3528OtherBCBS FL
FLU3528TMedicare PIN
FLQ25576Medicare UPIN
FLU3528UMedicare PIN
FLU3528QMedicare PIN
FLU3528WMedicare PIN
FLU3528SMedicare PIN
FLU3528OtherBCBS FL
FLU3528OtherBCBS FL