Provider Demographics
NPI:1609809987
Name:BUCHHOLZ, EMILY L (PAC)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:L
Last Name:BUCHHOLZ
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:349 LAKE HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813
Mailing Address - Country:US
Mailing Address - Phone:863-651-4576
Mailing Address - Fax:
Practice Address - Street 1:1601 W TIMBERLANE DR
Practice Address - Street 2:SUITE 400 PLANT CITY PEDIATRICS
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566
Practice Address - Country:US
Practice Address - Phone:813-659-9800
Practice Address - Fax:813-659-9807
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103163363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant