Individual
DERRICK ANTONIO LEGOAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
12902 USF MAGNOLIA DR, TAMPA, FL 33612-9416
(813) 745-7365
(813) 449-8618
Mailing address
PO BOX 198441, ATLANTA, GA 30384-8441
(813) 745-7365
(813) 449-8618
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9107024
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010785200
—
FL
Enumeration date
02/25/2013
Last updated
03/09/2025
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