Provider Demographics
NPI:1487638227
Name:DENITTIS, FELICIA ANNE E (PA-C)
Entity Type:Individual
Prefix:
First Name:FELICIA ANNE
Middle Name:E
Last Name:DENITTIS
Suffix:
Gender:F
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 1:920 DOUG WHITE DR STE 460
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4182
Mailing Address - Country:US
Mailing Address - Phone:843-449-2336
Mailing Address - Fax:843-692-2174
Practice Address - Street 1:920 DOUG WHITE DR STE 460
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4182
Practice Address - Country:US
Practice Address - Phone:843-449-2336
Practice Address - Fax:843-692-2174
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC925363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0224PAMedicaid
SC0224PAMedicaid
P34016Medicare UPIN