Organization
JAMES A HALEY VA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL LYNN LIEDTKE PA-C (PHYSICIAN ASSISTANT)
(813) 972-2000
Entity
Organization
Contact information
Practice address
13000 BRUCE B DOWNS BLVD, TAMPA, FL 33612-4745
(813) 972-2000
Mailing address
7142 QUEEN PALM CIR, SARASOTA, FL 34243-5038
Taxonomy
Speciality
Code
Description
License number
State
286500000X
Military Hospital
Primary
PA9101925
FL
Other
Enumeration date
08/08/2006
Last updated
08/22/2020
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