Individual
AUDREY CATHERINE MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
ONE DAVID BLVD, SUITE 503, TAMPA, FL 33606
(813) 627-5973
Mailing address
1 TAMPA GENERAL CIR, TAMPA, FL 33606-3571
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9107343
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012376400
—
FL
01
—
HV925Z
MEDICARE PTAN
FL
01
—
Y0MK9
BSFL
FL
Enumeration date
10/09/2012
Last updated
04/27/2017
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