Provider Demographics
NPI:1477598886
Name:WOJCIECHOWSKI, SCOTT W (PA-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:WOJCIECHOWSKI
Suffix:
Gender:M
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:PO BOX 2198
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32158-2198
Mailing Address - Country:US
Mailing Address - Phone:352-633-1966
Mailing Address - Fax:352-633-1969
Practice Address - Street 1:1050 OLD CAMP RD
Practice Address - Street 2:STE 270
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-1762
Practice Address - Country:US
Practice Address - Phone:352-633-1966
Practice Address - Fax:352-633-1969
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101385363AS0400X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5010OtherBCBS FL
FL290879400Medicaid
FL290879400Medicaid
FLE5010OtherBCBS FL
FLP22648Medicare UPIN
FLE5010NMedicare PIN