Provider Demographics
NPI:1245530468
Name:LENHARDT, EMILY EARLE (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:EARLE
Last Name:LENHARDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:EARLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2299 9TH AVE N
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713
Mailing Address - Country:US
Mailing Address - Phone:727-321-3344
Mailing Address - Fax:727-321-3236
Practice Address - Street 1:2299 9TH AVE N
Practice Address - Street 2:SUITE 3B
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-6800
Practice Address - Country:US
Practice Address - Phone:727-321-3344
Practice Address - Fax:727-321-3236
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105675363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1095335OtherCERTIFICATION