Provider Demographics
NPI:1801369459
Name:LENTZ, TAYLOR ANN (PA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANN
Last Name:LENTZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6700 CROSSWINDS DR N STE 200A
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5473
Mailing Address - Country:US
Mailing Address - Phone:727-344-4651
Mailing Address - Fax:
Practice Address - Street 1:6700 CROSSWINDS DR N STE 200A
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5473
Practice Address - Country:US
Practice Address - Phone:727-344-4651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111864363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant