Provider Demographics
NPI:1376392134
Name:LEA, PAIGE VICTORIA (PA-C)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:VICTORIA
Last Name:LEA
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 1:8344 W SLOAN ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-2189
Mailing Address - Country:US
Mailing Address - Phone:208-409-3576
Mailing Address - Fax:
Practice Address - Street 1:4700 EXCHANGE CT STE 18533431
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4450
Practice Address - Country:US
Practice Address - Phone:561-241-6676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant