Provider Demographics
NPI:1427591809
Name:WOLF, DEMYTRA (PA)
Entity Type:Individual
Prefix:
First Name:DEMYTRA
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:5400 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-3833
Mailing Address - Country:US
Mailing Address - Phone:352-277-5305
Mailing Address - Fax:352-616-0926
Practice Address - Street 1:13090 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3733
Practice Address - Country:US
Practice Address - Phone:772-589-3755
Practice Address - Fax:772-589-2315
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2023-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9108710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant