Provider Demographics
NPI:1467332304
Name:BATES, ALYSSA LEA
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LEA
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 1:11596 WALSINGHAM RD STE B
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-2511
Mailing Address - Country:US
Mailing Address - Phone:727-776-2610
Mailing Address - Fax:
Practice Address - Street 1:11596 WALSINGHAM RD STE B
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2511
Practice Address - Country:US
Practice Address - Phone:727-776-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty