Provider Demographics
NPI:1598067654
Name:SOMMERS CORMIER, ANGELA PATRICIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:PATRICIA
Last Name:SOMMERS CORMIER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:PATRICIA
Other - Last Name:SOMMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5810 CANDYTUFT PL
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-2646
Mailing Address - Country:US
Mailing Address - Phone:813-435-3897
Mailing Address - Fax:866-404-2708
Practice Address - Street 1:5810 CANDYTUFT PL
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-2646
Practice Address - Country:US
Practice Address - Phone:813-435-3897
Practice Address - Fax:866-404-2708
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105682363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FMP01190735OtherR&R MEDICARE
FMP01190735OtherR&R MEDICARE