Individual provider Active NPI

Angelina Ledezma, PA-C

  • Physician Assistant
  • St Petersburg, FL
National Provider Identifier
1417855545
Registry record updated Oct 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9122246 Issued in FL
Practice address
701 6TH St S
St Petersburg, FL 33701-4814
Phone
(727) 823-1234
NPI assigned
Oct 28, 2026
Last updated
Oct 30, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9122246 FL Primary

Addresses

Primary practice location

701 6TH St S
St Petersburg, FL 33701-4814

Mailing address

2480 13TH Ave N Apt 206
St Petersburg, FL 33713-5853
Phone (813) 474-9804

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1793145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1793318400000",
    "number": "1417855545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2480 13TH AVE N APT 206",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337135853",
            "telephone_number": "813-474-9804",
            "fax_number": "813-540-6025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 6TH ST S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014814",
            "telephone_number": "727-823-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEDEZMA",
        "first_name": "ANGELINA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-10-28",
        "last_updated": "2026-10-30",
        "certification_date": "2026-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9122246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.