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NPI Code Detail

MEDICARE: SUMMER STAGMAN

MEDICARE: SUMMER STAGMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant9120507FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043183148
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUMMER STAGMAN
Provider Business Mailing Address
First Line : PO BOX 2147
Second Line :
City : FORT MYERS
State : FL
Zip : 33902-2147
Country : US
Telephone Number : 239-424-2755
Fax Number :
Provider Business Practice Location Address
First Line : 708 DEL PRADO BLVD S STE 6
Second Line :
City : CAPE CORAL
State : FL
Zip : 33990-2661
Country : US
Telephone Number : 239-424-2755
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2025
Last Update Date : 12/09/2025

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Directions to “ SUMMER STAGMAN ” Practice Location

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