Healthcare Provider Details

I. General information

NPI: 1013744663
Provider Name (Legal Business Name): VICTORIA LEIGH ADE HARVEY PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 HEALTH CENTER BLVD STE 1050
ESTERO FL
34135-8130
US

IV. Provider business mailing address

PO BOX 2147 SUITE 100
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-468-0260
  • Fax: 239-343-4254
Mailing address:
  • Phone: 239-468-0260
  • Fax: 239-343-4254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119341
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: