Provider Demographics
NPI:1568187920
Name:HOVIS, OLIVIA NOELLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:NOELLE
Last Name:HOVIS
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 1:17260 LOSILLAS CIR UNIT 302
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-9580
Mailing Address - Country:US
Mailing Address - Phone:502-552-9865
Mailing Address - Fax:
Practice Address - Street 1:9021 PARK ROYAL DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9617
Practice Address - Country:US
Practice Address - Phone:239-432-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116531.208C00000X
FLPA9116531363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery