Provider Demographics
NPI:1114578853
Name:STOLLER, ERICA LEAH (PA-C)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LEAH
Last Name:STOLLER
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1117 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4488
Mailing Address - Country:US
Mailing Address - Phone:954-454-5131
Mailing Address - Fax:954-241-6908
Practice Address - Street 1:3501 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5421
Practice Address - Country:US
Practice Address - Phone:954-265-6301
Practice Address - Fax:954-985-1434
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL91125322080P0203X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine