Provider Demographics
NPI:1518064773
Name:BOYD, ERIN LOCKER (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LOCKER
Last Name:BOYD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:NICOLE
Other - Last Name:LOCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:6420 W NEWBERRY RD STE 100
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6622
Practice Address - Country:US
Practice Address - Phone:352-332-3900
Practice Address - Fax:352-332-5009
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103805363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292549400Medicaid
FL292549400Medicaid
Q74050Medicare UPIN