Provider Demographics
NPI:1639104730
Name:SYLVA, TASHA M (PA-C)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:M
Last Name:SYLVA
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-6202
Mailing Address - Fax:239-437-8537
Practice Address - Street 1:16410 HEALTHPARK COMMONS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9621
Practice Address - Country:US
Practice Address - Phone:239-343-6202
Practice Address - Fax:239-437-8537
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103127363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014867400Medicaid
FLK7665OtherMEDICARE GROUP
FLU5623WOtherMEDICARE
FLK7129Medicare ID - Type UnspecifiedMEDCIARE GROUP NO.