Provider Demographics
NPI:1497383053
Name:SHOULTS, LAINIE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAINIE
Middle Name:
Last Name:SHOULTS
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 1:4601 VINEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-4657
Mailing Address - Country:US
Mailing Address - Phone:239-560-1925
Mailing Address - Fax:
Practice Address - Street 1:4601 VINEWOOD CIR
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-4657
Practice Address - Country:US
Practice Address - Phone:239-560-1925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant