Provider Demographics
NPI:1487417788
Name:BAYLINE, ERICA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:MARIE
Last Name:BAYLINE
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 1:719 S BUNGALOW TER
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2538
Mailing Address - Country:US
Mailing Address - Phone:321-917-7034
Mailing Address - Fax:
Practice Address - Street 1:3440 W DR MARTIN LUTHER KING JR BLVD STE 203
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6223
Practice Address - Country:US
Practice Address - Phone:813-872-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9118441363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant