MEDICARE: MS. AVERY HOSHOR PA

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1639790348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AVERY HOSHOR PA

Provider Business Mailing Address
First Line	:	1850 SE 18TH AVE APT 1108
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34471-8255
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 SW 17TH ST STE A
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34471-8104
Country	:	US
Telephone Number	:	352-512-9996
Fax Number	:

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

Provider Enumeration Date	:	05/04/2020
Last Update Date	:	05/04/2020

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