Provider Demographics
NPI:1417134081
Name:HOUGHTON, LESLIE CAROL (PA-C)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:CAROL
Last Name:HOUGHTON
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 1:301 NE 167TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2304
Mailing Address - Country:US
Mailing Address - Phone:305-940-0522
Mailing Address - Fax:
Practice Address - Street 1:301 NE 167TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2304
Practice Address - Country:US
Practice Address - Phone:305-940-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-26
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104413363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical