Provider Demographics
NPI:1972168052
Name:FREED, CARLEE (PA)
Entity Type:Individual
Prefix:
First Name:CARLEE
Middle Name:
Last Name:FREED
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 1:960 7TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1347
Mailing Address - Country:US
Mailing Address - Phone:727-821-8101
Mailing Address - Fax:727-825-1357
Practice Address - Street 1:2191 9TH AVE N STE 270
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7149
Practice Address - Country:US
Practice Address - Phone:727-821-8101
Practice Address - Fax:727-825-1357
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-05
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9112235363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical