Provider Demographics
NPI:1376731216
Name:LAKE, FAITH ARLEEN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:FAITH
Middle Name:ARLEEN
Last Name:LAKE
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:PO BOX 7354
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-0354
Mailing Address - Country:US
Mailing Address - Phone:340-714-3278
Mailing Address - Fax:340-714-3279
Practice Address - Street 1:9048 SUGAR ESTATE
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-714-3278
Practice Address - Fax:340-714-3279
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI016363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI016OtherPHYSICIAN ASSISTANT
363A00000XOtherTAXONOMY CODE