| Doctor Name: | MISS LAKEISHA L PORTER |
| NPI Number: | 1063417889 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | PA9102987 |
| Business Practice Address: | 13020 N Telecom Pkwy Temple Terrace, FL - 336370925 |
| Business Phone Number: | 8139789700 |
| Business Fax Number: | 8139725055 |
| Mailing Address: | 5802 N 30th St, TAMPA |
| State: | FL |
| Postal Code: | 336101469 |
| Phone Number: | 8132355200 |
| Fax Number: | 8132365222 |
| NPI Enumeration Date: | 06/17/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA9102987 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |