MEDICARE: MRS. ALISSA MARIE MEYER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PAT9114894	FL
2	390200000X	Student in an Organized Health Care Education/Training Program
3	363AM0700X	Medical Physician Assistant	PA9114894	FL

General Provider Information

NPI Number	:	1285260661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALISSA MARIE MEYER PA-C

Provider Business Mailing Address
First Line	:	11011 SHERIDAN ST STE 302
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-1532
Country	:	US
Telephone Number	:	954-437-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	11011 SHERIDAN ST STE 302
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-1532
Country	:	US
Telephone Number	:	954-437-1500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2020
Last Update Date	:	03/07/2022

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