Provider Demographics
NPI:1619451648
Name:LEAST, LAURA CLARK (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:CLARK
Last Name:LEAST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1705 MAHAN DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5201
Mailing Address - Country:US
Mailing Address - Phone:850-877-7164
Mailing Address - Fax:850-656-1391
Practice Address - Street 1:1705 MAHAN DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5201
Practice Address - Country:US
Practice Address - Phone:850-877-7164
Practice Address - Fax:850-656-1391
Is Sole Proprietor?:No
Enumeration Date:2018-09-15
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111542363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical