Provider Demographics
NPI:1750268009
Name:DOUBEK, KYLA PAIGE (PA-C)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:PAIGE
Last Name:DOUBEK
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 1:1416 LOCUST ST NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4733
Mailing Address - Country:US
Mailing Address - Phone:419-612-2520
Mailing Address - Fax:
Practice Address - Street 1:1416 LOCUST ST NE APT A
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-4733
Practice Address - Country:US
Practice Address - Phone:419-612-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9120268363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant