Individual
LEILANI PHELAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
15320 AMBERLY DR, SUITE A, TAMPA, FL 33647-1647
(813) 977-2090
(813) 977-9107
Mailing address
15320 AMBERLY DR, SUITE B, TAMPA, FL 33647-1647
(813) 977-0733
(813) 971-2230
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9106375
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA9106375
STATE LICENSE
FL
Enumeration date
01/09/2012
Last updated
05/15/2019
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