MS. AUDREY C SEVILLA-BALLEREAU PA-C NPI 1225213200

NPI Information

NPI: 1225213200
Provider Name: MS. AUDREY C SEVILLA-BALLEREAU, PA-C
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

PECOS Registration: Yes

Address:
3003 W DR MARTIN LUTHER KING JR BLVD
2ND MAB
TAMPA, FL
ZIP 33607
Phone: (813) 321-6580
Get Directions

MS. Audrey C Sevilla-ballereau, PA-C is a surgical physician assistant in Tampa, FL with 17 years of experience. MS. Audrey C Sevilla-ballereau, PA-C NPI is 1225213200. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: MERCY COLLEGE
Graduation Year:2007

The provider's business location address is:

3003 W DR MARTIN LUTHER KING JR BLVD
2ND MAB
TAMPA, FL
ZIP 33607-307
Phone: (813) 321-6580
Fax: (813) 443-8135

The NPI 1225213200 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/8/2008 and was last updated on 4/13/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363A00000X	Physician Assistant		PA9108569	FLORIDA	No
2	363AS0400X	Physician Assistant	Surgical	PA9108569	FLORIDA	Yes
3	363AS0400X	Physician Assistant	Surgical	PA-070	GUAM	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	014813700	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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