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General NPI Number Information
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NPI Number | 1265805881
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Entity Type | Individual
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Provider Name | ESTEFANIE A WITTEMAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/04/2015
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 1730 SW SAINT LUCIE WEST BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-2504
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Country | US
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Telephone | 772-873-8155
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Fax |
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Provider Business Mailing Address
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Address Line | 584 SW SQUIRE JOHNS LN
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City | PALM CITY
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State | FL
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Zip | 34990-7823
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9109258
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License Number State | FL
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