Provider Demographics
NPI:1710919550
Name:MYERS, LESLEY P (PAC)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:P
Last Name:MYERS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:P
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-392-4984
Practice Address - Fax:352-265-0153
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2273363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
U2013ZMedicare PIN
Q07788Medicare UPIN