Provider Demographics
NPI:1023040706
Name:WEST, DENISE M (PA-C)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:WEST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 SUMMERLIN COMMONS BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2149
Mailing Address - Country:US
Mailing Address - Phone:239-232-1180
Mailing Address - Fax:
Practice Address - Street 1:8340 LAKEWOOD RANCH BLVD STE 260
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5182
Practice Address - Country:US
Practice Address - Phone:941-218-1711
Practice Address - Fax:941-955-9806
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102425363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6146YOtherPTAN
FLU6146YOtherPTAN