Individual
MS. AUDREY C SEVILLA-BALLEREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3003 W DR MARTIN LUTHER KING JR BLVD, 2ND MAB, TAMPA, FL 33607-6307
(813) 321-6580
(813) 443-8135
Mailing address
3003 W DR MARTIN LUTHER KING JR BLVD, MAB 2ND FLOOR, TAMPA, FL 33607
(813) 321-6580
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9108569
FL
363AS0400X
Surgical Physician Assistant
PA-070
GU
363AS0400X
Surgical Physician Assistant
Primary
PA9108569
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014813700
—
FL
Enumeration date
01/08/2008
Last updated
04/13/2023
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