Individual
MRS. LAURIE BETH WALDRON
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., TAMPA, FL 33607-6307
(813) 554-8384
(813) 443-8160
Mailing address
3003 W DR MLK BLVD FL JR3, TAMPA, FL 33607-6307
(813) 554-8983
(813) 443-8177
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9105505
FL
363AS0400X
Surgical Physician Assistant
Primary
PA9105505
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0092489-00
—
FL
Enumeration date
03/22/2012
Last updated
04/13/2023
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