Provider Demographics
NPI:1457550014
Name:IKENBERRY, ERIN ANNE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:ANNE
Last Name:IKENBERRY
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 1:9988 LAKE SEMINOLE DR W
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-4551
Mailing Address - Country:US
Mailing Address - Phone:813-635-6106
Mailing Address - Fax:
Practice Address - Street 1:4004 N RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3212
Practice Address - Country:US
Practice Address - Phone:813-296-8318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011877363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical