Provider Demographics
NPI:1508245911
Name:LEEK, JOSHUA
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:LEEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 3RD AVE N
Mailing Address - Street 2:UNIT 509
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3350
Mailing Address - Country:US
Mailing Address - Phone:615-604-1456
Mailing Address - Fax:
Practice Address - Street 1:6006 49TH ST N
Practice Address - Street 2:SUITE 310
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2148
Practice Address - Country:US
Practice Address - Phone:727-527-9779
Practice Address - Fax:727-522-0415
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108643363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical