Provider Demographics
NPI:1851799225
Name:LEDESMA, CARMEN MERCEDES (PA-C)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:MERCEDES
Last Name:LEDESMA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 BAXTER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4331
Mailing Address - Country:US
Mailing Address - Phone:305-331-6960
Mailing Address - Fax:
Practice Address - Street 1:1409 BAXTER RIDGE CT
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4331
Practice Address - Country:US
Practice Address - Phone:305-331-6960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108123363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant