Provider Demographics
NPI:1679849707
Name:WALDRON, LAURIE BETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:BETH
Last Name:WALDRON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:BETH
Other - Last Name:SILVERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3003 W DR MLK BLVD FL JR3
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6307
Mailing Address - Country:US
Mailing Address - Phone:813-554-8983
Mailing Address - Fax:813-443-8177
Practice Address - Street 1:3003 W. DR. MARTIN LUTHER KING JR. BLVD.
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6307
Practice Address - Country:US
Practice Address - Phone:813-554-8384
Practice Address - Fax:813-443-8160
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105505363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0092489-00Medicaid
FL0092489-00Medicaid