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General NPI Number Information
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NPI Number | 1396301693
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Entity Type | Individual
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Provider Name | MICHAEL OVERMAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 07/05/2024
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Provider Practice Location Address
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Address Line | 119 OAKFIELD DR
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City | BRANDON
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State | FL
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Zip | 33511-5779
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Country | US
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Telephone | 813-681-5551
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Fax |
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Provider Business Mailing Address
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Address Line | 3039 RIDGEVALE CIR
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City | VALRICO
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State | FL
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Zip | 33596-5660
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3781
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License Number State | SC
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