Provider Demographics
NPI:1346302338
Name:STOVER, MELANIE (PA-C)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:STOVER
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 STE 400
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2151
Mailing Address - Country:US
Mailing Address - Phone:239-598-4004
Mailing Address - Fax:
Practice Address - Street 1:9125 CORSEA DEL FONTANA WAY STE 100
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-4430
Practice Address - Country:US
Practice Address - Phone:239-598-4004
Practice Address - Fax:239-598-4713
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104600363A00000X
MI5601004826363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
N13100007Medicare PIN