Provider Demographics
NPI:1811635865
Name:MCMAHON, ELIZABETH LEIGH (PA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEIGH
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:4651 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-4880
Mailing Address - Country:US
Mailing Address - Phone:813-321-1786
Mailing Address - Fax:813-321-1787
Practice Address - Street 1:4651 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-4880
Practice Address - Country:US
Practice Address - Phone:813-321-1786
Practice Address - Fax:813-321-1787
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9116271363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant