MEDICARE: KAREN ANNE MIKOL PA

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	PA9105644	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	N8651	OTHER	FL	MEDICARE PTAN

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
3	Y07TU	OTHER	FL	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962710715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN ANNE MIKOL PA

Provider Business Mailing Address
First Line	:	4790 BARKLEY CIR STE A
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-7593
Country	:	US
Telephone Number	:	239-275-8882
Fax Number	:	239-275-5251

Provider Business Practice Location Address
First Line	:	4790 BARKLEY CIR STE A
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-7593
Country	:	US
Telephone Number	:	239-275-8882
Fax Number	:	239-275-5251

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

Provider Enumeration Date	:	09/15/2010
Last Update Date	:	02/10/2022

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Directions to “ KAREN ANNE MIKOL PA” Practice Location

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