Doctor Name: | LETICIA S WORSHAM |
NPI Number: | 1013912849 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA |
License Number: | PA9102612 |
Business Practice Address: | 13020 N Telecom Pkwy Temple Terrace, FL - 336370925 |
Business Phone Number: | 8139789700 |
Business Fax Number: | 8139725055 |
Mailing Address: | 13020 N Telecom Pkwy, TEMPLE TERRACE |
State: | FL |
Postal Code: | 336370925 |
Phone Number: | 8139789700 |
Fax Number: | 8139725055 |
NPI Enumeration Date: | 06/17/2005 |
NPI Last Update Date: | 12/13/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA9102612 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |