Most Relevant Information
Provider Data
| NPI Number: | 1003454786 |
| Provider Name: | ERICA LYNN IKETANI PA |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | PA9112811 |
Most Important Dates
| Enumeration Date: | 12/13/2019 |
| Last Updated: | 11/09/2020 |
Provider Practice Location
1600 SW ARCHER RD RM 10-504
GAINESVILLE
FL
326103003
Practice Location Phone/Fax
| Phone: | 3522650462 |
| Fax: |
Provider Mailing Location
2114 SW 102ND TER
GAINESVILLE
FL
326073254
Provider Mailing Phone/Fax
| Phone: | 3219879095 |
| Fax: |