MEDICARE: MRS. OLIVIA LAUREL STOLZ 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	9111738	FL
2	363AS0400X	Surgical Physician Assistant	9111738	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336610856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. OLIVIA LAUREL STOLZ PA-C

Provider Business Mailing Address
First Line	:	5901 E FOWLER AVE STE 100
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617-2305
Country	:	US
Telephone Number	:	813-978-9700
Fax Number	:	813-558-6185

Provider Business Practice Location Address
First Line	:	740 W PLYMOUH AVE
Second Line	:	SUITE 100
City	:	DELAND
State	:	FL
Zip	:	32720
Country	:	US
Telephone Number	:	813-978-9700
Fax Number	:

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

Provider Enumeration Date	:	12/10/2018
Last Update Date	:	04/17/2026

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