Provider Demographics
NPI:1790737609
Name:SIGNORE, STEPHEN JOSEPH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:SIGNORE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:STEPHEN
Other - Middle Name:JOSEPH
Other - Last Name:SIGNORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:12421 HAMMOCK POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8089
Mailing Address - Country:US
Mailing Address - Phone:352-267-1550
Mailing Address - Fax:
Practice Address - Street 1:401 W NORTH BLVD
Practice Address - Street 2:MID-FLORIDA PRIMARY CARE, PA
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5044
Practice Address - Country:US
Practice Address - Phone:352-728-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2754363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290244300Medicaid
FLE2003PMedicare PIN