Provider Demographics
NPI:1285134031
Name:PINKERD, ALYSHA (PA-C)
Entity type:Individual
Prefix:MS
First Name:ALYSHA
Middle Name:
Last Name:PINKERD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 4TH AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4403
Mailing Address - Country:US
Mailing Address - Phone:619-409-3605
Mailing Address - Fax:194-265-9646
Practice Address - Street 1:480 4TH AVE STE 307
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4403
Practice Address - Country:US
Practice Address - Phone:619-409-3605
Practice Address - Fax:194-265-9646
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112089363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103474400Medicaid