Healthcare Provider Details

I. General information

NPI: 1124842497
Provider Name (Legal Business Name): STEVEN KENNETH ANASCAVAGE JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13778 PLANTATION RD
FORT MYERS FL
33912-4301
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-0454
  • Fax: 239-343-1078
Mailing address:
  • Phone: 239-343-0454
  • Fax: 239-343-1078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119479
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: