Individual
LIESA CLARE ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
603 7TH ST S, ST PETERSBURG, FL 33701-4719
(727) 893-6254
(727) 553-7158
Mailing address
603 7TH ST S, ST PETERSBURG, FL 33701-4719
(727) 893-6254
(727) 553-7158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
PA9115833
FL
390200000X
Student in an Organized Health Care Education/Training Program
STUDENT
MN
Other
Enumeration date
10/29/2020
Last updated
01/02/2024
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