MEDICARE: MRS. HOLLY ANN LOEBL 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	PA9102707	FL
2	363A00000X	Physician Assistant	PA9102707	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	391595	OTHER	FL	WELLCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962490177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY ANN LOEBL PA-C

Provider Business Mailing Address
First Line	:	258 S CHICKASAW TRL STE 200
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-3501
Country	:	US
Telephone Number	:	407-303-6865
Fax Number	:	407-303-6537

Provider Business Practice Location Address
First Line	:	258 S CHICKASAW TRL STE 200
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-3501
Country	:	US
Telephone Number	:	407-303-6865
Fax Number	:	407-303-6537

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	09/01/2020

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Directions to “ MRS. HOLLY ANN LOEBL PA-C” Practice Location

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