MEDICARE: MS. STACI LYNNE HOVITCH 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	363AM0700X	Medical Physician Assistant	PA2856	FL

General Provider Information

NPI Number	:	1346328739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STACI LYNNE HOVITCH PA-C

Provider Business Mailing Address
First Line	:	773 4TH AVE N
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-5778
Country	:	US
Telephone Number	:	239-775-3535
Fax Number	:

Provider Business Practice Location Address
First Line	:	773 4TH AVE N
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-5778
Country	:	US
Telephone Number	:	239-775-3535
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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