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General NPI Number Information
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NPI Number | 1255639142
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Entity Type | Individual
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Provider Name | NICOLE WILBURN STOKES PA-C, ATC
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Gender | Female
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 2231 NORTH BLVD W A
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City | DAVENPORT
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State | FL
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Zip | 33837-8990
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Country | US
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Telephone | 863-419-9301
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Fax |
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Provider Business Mailing Address
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Address Line | 3817 ERIC CT
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City | LAKELAND
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State | FL
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Zip | 33813-1231
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Country | US
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Telephone | 863-604-1235
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9105879
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License Number State | FL
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