Provider Demographics
NPI:1386898237
Name:MCCLEES, ANGELA M (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:MCCLEES
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:EASTBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-844-7000
Mailing Address - Fax:
Practice Address - Street 1:10647 BIG BEND RD STE 212
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7176
Practice Address - Country:US
Practice Address - Phone:813-844-4600
Practice Address - Fax:813-844-1960
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1177363A00000X
FLPA9111465363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100063840Medicaid
FL104246500Medicaid