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NPI Code Detail

MEDICARE: LAURA ANNE STONAKER PA.C

MEDICARE: LAURA ANNE STONAKER PA.C
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
1363AM0700XMedical Physician AssistantPA0002846FL
2363A00000XPhysician AssistantPA2846FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2Y00SAOTHERFLBLUE CROSS BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225026503
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA ANNE STONAKER PA.C
Provider Business Mailing Address
First Line : PO BOX 935921
Second Line :
City : ATLANTA
State : GA
Zip : 31193-5921
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 301 MEMORIAL MEDICAL PKWY
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32117-5167
Country : US
Telephone Number : 386-231-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2005
Last Update Date : 10/08/2024

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