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Agustin
Agustin
Ancaya
Hospitalist
Medical doctor
Lakeland,
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Florida Board of Medicine
Board Name
BOARD OF MEDICINE
Full name
Agustin Ancaya
Job Title
Medical Doctor
License Number
ME92104
License Status
Clear/Active
License Issue Date
13/12/2004
License Expiry Date
31/01/2025
Source Type
Professional Profile
Florida Health Care Practitioner Data Portal
Full name
AGUSTIN ANCAYA
Job Title
Medical Doctor
Location
Lakeland, FL, USA
Title
MD
LIC ID
90042
Current License Expiration Date
31/01/2025
Original Date
13/12/2004
Professional Rank Code
ME
Effective Date
27/01/2015
Board Action Indicator
N
License Status Description
CLEAR
License Active Status Description
ACTIVE
Country Description
POLK
Practice Location Address Line 1
1600 LAKELAND HILLS BLVD
Practice Location Address City
LAKELAND
Practice Location Address State
FL
Practice Location Address Zipcode
33805
Prescribing Indicator
N
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