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General NPI Number Information
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NPI Number | 1992538300
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Entity Type | Individual
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Provider Name | WOLF ISMAKOV JEAN BAPTISTE PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/21/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 13681 DOCTORS WAY
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City | FORT MYERS
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State | FL
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Zip | 33912-4300
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Country | US
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Telephone | 239-343-0434
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Fax |
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Provider Business Mailing Address
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Address Line | 3811 NW 28TH ST
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33311-1832
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Country | US
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Telephone | 754-779-6278
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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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