Provider Demographics
NPI:1104178805
Name:HEAD, STEVEN M (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:M
Last Name:HEAD
Suffix:
Gender:M
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 1:1920 SW 20TH PL
Mailing Address - Street 2:#100
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7881
Mailing Address - Country:US
Mailing Address - Phone:352-237-1212
Mailing Address - Fax:352-237-0066
Practice Address - Street 1:1920 SW 20TH PL
Practice Address - Street 2:#100
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7881
Practice Address - Country:US
Practice Address - Phone:352-237-1212
Practice Address - Fax:352-237-0066
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106785363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0H7DOtherBCBS
FLGR706ZOtherMEDICARE ID
FLK0795OtherMEDICARE
FLGR706ZOtherMEDICARE ID