MEDICARE: MS. ANNA ELIZABETH WHITTINGTON 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	2445	GA
2	363AM0700X	Medical Physician Assistant	PA9107492	FL

General Provider Information

NPI Number	:	1568700490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNA ELIZABETH WHITTINGTON PA-C

Provider Business Mailing Address
First Line	:	7960 N. WICKHAM ROAD
Second Line	:	SUITE 103
City	:	MELBOURNE
State	:	FL
Zip	:	32940-8096
Country	:	US
Telephone Number	:	321-428-4737
Fax Number	:	321-241-6457

Provider Business Practice Location Address
First Line	:	7960 N. WICKHAM ROAD
Second Line	:	SUITE 103
City	:	MELBOURNE
State	:	FL
Zip	:	32940-8096
Country	:	US
Telephone Number	:	321-428-4737
Fax Number	:	321-241-6457

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

Provider Enumeration Date	:	01/28/2013
Last Update Date	:	02/21/2020

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