Individual
KEISHA MARIE POLEON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2919 W SWANN AVE STE 106, TAMPA, FL 33609-4049
(813) 930-2829
(813) 930-9522
Mailing address
8500 HUNTERS VILLAGE RD UNIT 361, TAMPA, FL 33647-3809
(256) 426-8210
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9117189
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118654700
—
FL
01
—
R6341
MEDICARE PTAN
FL
01
—
WN769
FL BLUE
FL
Enumeration date
03/23/2023
Last updated
03/27/2024
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