Provider Demographics
NPI:1396731618
Name:TALBOT, VISHIA M (PA-C)
Entity type:Individual
Prefix:
First Name:VISHIA
Middle Name:M
Last Name:TALBOT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VISHIA
Other - Middle Name:M
Other - Last Name:SULE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1600 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3019
Mailing Address - Country:US
Mailing Address - Phone:863-680-7000
Mailing Address - Fax:866-264-8519
Practice Address - Street 1:1600 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3019
Practice Address - Country:US
Practice Address - Phone:863-680-7214
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102566363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291727100Medicaid
FL291727100Medicaid
FL0471260001Medicare NSC