MEDICARE: ESTEFANIE A WITTEMAN 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
1	363A00000X	Physician Assistant	PA9109258	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1265805881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTEFANIE A WITTEMAN PA-C

Provider Business Mailing Address
First Line	:	584 SW SQUIRE JOHNS LN
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-7823
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 SW SAINT LUCIE WEST BLVD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-2504
Country	:	US
Telephone Number	:	772-873-8155
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	12/16/2024

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