Provider Demographics
NPI:1770685729
Name:SANBORN, CATHY LYNN (PA)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:LYNN
Last Name:SANBORN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10225 ULMERTON RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3538
Mailing Address - Country:US
Mailing Address - Phone:727-526-2771
Mailing Address - Fax:727-584-4764
Practice Address - Street 1:1180 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-1014
Practice Address - Country:US
Practice Address - Phone:727-581-3171
Practice Address - Fax:727-581-0871
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103732363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant