Provider Demographics
NPI:1205618741
Name:LEEK, BRADEN HUNTER (PA-C)
Entity type:Individual
Prefix:
First Name:BRADEN
Middle Name:HUNTER
Last Name:LEEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:602 VONDERBURG DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5900
Mailing Address - Country:US
Mailing Address - Phone:813-685-5500
Mailing Address - Fax:813-653-1379
Practice Address - Street 1:602 VONDERBURG DR STE 101
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5900
Practice Address - Country:US
Practice Address - Phone:813-685-5500
Practice Address - Fax:813-653-1379
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9118085363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical