Provider Demographics
NPI:1851879217
Name:LEBARON, JESSE (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:LEBARON
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8451 SHADE AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2878
Mailing Address - Country:US
Mailing Address - Phone:941-360-2477
Mailing Address - Fax:941-360-2577
Practice Address - Street 1:8451 SHADE AVE STE 205
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2878
Practice Address - Country:US
Practice Address - Phone:941-360-2477
Practice Address - Fax:941-360-2577
Is Sole Proprietor?:No
Enumeration Date:2018-07-29
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111415207N00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207N00000XAllopathic & Osteopathic PhysiciansDermatology