Healthcare Provider Details

I. General information

NPI: 1346328739
Provider Name (Legal Business Name): STACI LYNNE HOVITCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACI LYNNE REAGAN PA-C

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 4TH AVE N
NAPLES FL
34102-5778
US

IV. Provider business mailing address

773 4TH AVE N
NAPLES FL
34102-5778
US

V. Phone/Fax

Practice location:
  • Phone: 239-775-3535
  • Fax:
Mailing address:
  • Phone: 239-775-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2856
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: