Provider Demographics
NPI:1346791399
Name:PATEL, ANITA S (PA)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-2030
Mailing Address - Fax:239-343-4116
Practice Address - Street 1:507 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2618
Practice Address - Country:US
Practice Address - Phone:239-772-0500
Practice Address - Fax:239-772-3076
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109339363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4149000OtherAETNA
FLKI20WOtherBCBS
FL019201400Medicaid
FLIV705ZOtherRR MEDICARE
FLP1047846OtherFREEDOM
FL398582OtherAVMED
FL8721449OtherCIGNA
FLP983871OtherOPTIMUM
FLP01792360OtherRR MEDICARE