MEDICARE: LAINIE SHOULTS 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

General Provider Information

NPI Number	:	1497383053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAINIE SHOULTS PA-C

Provider Business Mailing Address
First Line	:	4601 VINEWOOD CIR
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-4657
Country	:	US
Telephone Number	:	239-560-1925
Fax Number	:

Provider Business Practice Location Address
First Line	:	4601 VINEWOOD CIR
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-4657
Country	:	US
Telephone Number	:	239-560-1925
Fax Number	:

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

Provider Enumeration Date	:	03/30/2020
Last Update Date	:	03/30/2020

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Directions to “ LAINIE SHOULTS PA-C” Practice Location

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