Healthcare Provider Details

I. General information

NPI: 1447009717
Provider Name (Legal Business Name): MS. LOVIA KONOPASEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-8262
US

IV. Provider business mailing address

PO BOX 100294
GAINESVILLE FL
32610-0294
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-6200
  • Fax: 352-265-0281
Mailing address:
  • Phone: 352-273-7584
  • Fax: 352-392-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119002
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: