Provider Demographics
NPI:1992538300
Name:JEAN BAPTISTE, WOLF ISMAKOV (PA-C)
Entity type:Individual
Prefix:
First Name:WOLF
Middle Name:ISMAKOV
Last Name:JEAN BAPTISTE
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3811 NW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1832
Mailing Address - Country:US
Mailing Address - Phone:754-779-6278
Mailing Address - Fax:
Practice Address - Street 1:13681 DOCTORS WAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4300
Practice Address - Country:US
Practice Address - Phone:239-343-0434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-10-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant