Provider Demographics
NPI:1609854876
Name:STOIKE, PAMELA JEAN (PAC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:STOIKE
Suffix:
Gender:F
Credentials:PAC
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 4059
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07474-4059
Mailing Address - Country:US
Mailing Address - Phone:973-826-8080
Mailing Address - Fax:888-972-6480
Practice Address - Street 1:4215 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-2206
Practice Address - Country:US
Practice Address - Phone:973-826-8080
Practice Address - Fax:888-972-6480
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002539363A00000X
FLPA9108871363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00339334OtherMEDICARE RAILROAD
IL02222323OtherBCBS
FLIS471WOtherQSS SOUTHEAST CLINICAL SERVICES - PTAN
ILP00339334OtherMEDICARE RAILROAD
ILK21065Medicare PIN