Provider Demographics
NPI:1659880532
Name:STONE, EMILY MICHELE (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MICHELE
Last Name:STONE
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 1:10062 SW CHADWICK DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2418
Mailing Address - Country:US
Mailing Address - Phone:703-217-0899
Mailing Address - Fax:
Practice Address - Street 1:10023 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5643
Practice Address - Country:US
Practice Address - Phone:772-398-5339
Practice Address - Fax:772-337-2666
Is Sole Proprietor?:No
Enumeration Date:2017-09-24
Last Update Date:2017-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110686363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant