Provider Demographics
NPI:1346328739
Name:HOVITCH, STACI LYNNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STACI
Middle Name:LYNNE
Last Name:HOVITCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:STACI
Other - Middle Name:LYNNE
Other - Last Name:REAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:773 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5778
Mailing Address - Country:US
Mailing Address - Phone:239-775-3535
Mailing Address - Fax:
Practice Address - Street 1:773 4TH AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5778
Practice Address - Country:US
Practice Address - Phone:239-775-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2856363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical