Provider Demographics
NPI:1376773697
Name:FORD, AUDREY FRIEDLAND (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:FRIEDLAND
Last Name:FORD
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:4919 MEMORIAL HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7516
Mailing Address - Country:US
Mailing Address - Phone:813-333-1512
Mailing Address - Fax:813-333-1561
Practice Address - Street 1:4197 WOODLANDS PKWY
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3493
Practice Address - Country:US
Practice Address - Phone:727-786-3810
Practice Address - Fax:727-786-3855
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105042363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110205300Medicaid