Provider Demographics
NPI:1477307593
Name:ALGATE, KEEGEN (PA-C)
Entity Type:Individual
Prefix:
First Name:KEEGEN
Middle Name:
Last Name:ALGATE
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 1:1472 KEYSTONE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-6334
Mailing Address - Country:US
Mailing Address - Phone:727-254-0498
Mailing Address - Fax:
Practice Address - Street 1:1472 KEYSTONE RIDGE CIR
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-6334
Practice Address - Country:US
Practice Address - Phone:727-254-0498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9118671363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant