Healthcare Provider Details

I. General information

NPI: 1356519417
Provider Name (Legal Business Name): JOANNA ELIZABETH STOVERINK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA ELIZABETH CALDERON PA

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 S CLYDE MORRIS BLVD STE 100
PORT ORANGE FL
32129-2300
US

IV. Provider business mailing address

4800 BELFORT RD
JACKSONVILLE FL
32256-6004
US

V. Phone/Fax

Practice location:
  • Phone: 386-788-1242
  • Fax: 386-756-8802
Mailing address:
  • Phone: 904-398-3262
  • Fax: 904-265-4807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 9104462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: