Provider Demographics
NPI:1558116434
Name:BATES, ADRIENNE ELIZABETH
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:ELIZABETH
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 GULF TO BAY BLVD APT 3301
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-4030
Mailing Address - Country:US
Mailing Address - Phone:240-285-0742
Mailing Address - Fax:
Practice Address - Street 1:2855 GULF TO BAY BLVD APT 3301
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-4030
Practice Address - Country:US
Practice Address - Phone:240-285-0742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9118569363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant