Provider Demographics
NPI:1356586788
Name:LUDERS, ERIN LEA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:LEA
Last Name:LUDERS
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 1:2137 N. COMMERCE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3238
Mailing Address - Country:US
Mailing Address - Phone:954-349-2345
Mailing Address - Fax:954-349-7784
Practice Address - Street 1:1600 TOWN CENTER BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3641
Practice Address - Country:US
Practice Address - Phone:954-389-5900
Practice Address - Fax:954-389-5751
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104729363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
3152876OtherUNITED HEALTHCARE