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General NPI Number Information
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NPI Number | 1962446377
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Entity Type | Individual
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Provider Name | MARK T STLAWRENCE PA
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 7751 BYAMEADOWS RD E SUITE H
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City | JACKSONVILLE
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State | FL
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Zip | 32256-5836
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Country | US
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Telephone | 904-425-6963
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Fax | 904-674-0155
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Provider Business Mailing Address
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Address Line | 2675 WINKLER AVE FL 2
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City | FORT MYERS
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State | FL
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Zip | 33901-9342
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Country | US
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Telephone | 877-856-3774
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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 | PA9103599
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License Number State | FL
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