Provider Demographics
NPI:1437395324
Name:STOKLOSA, ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:STOKLOSA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S HARBOR CITY BLVD STE 610
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5591
Mailing Address - Country:US
Mailing Address - Phone:321-723-7716
Mailing Address - Fax:321-723-0604
Practice Address - Street 1:2222 S HARBOR CITY BLVD STE 610
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5591
Practice Address - Country:US
Practice Address - Phone:321-723-7716
Practice Address - Fax:321-723-0604
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105437363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022305300Medicaid
FLY00U9OtherFLORIDA BLUE