Provider Demographics
NPI:1134160757
Name:HAMILTON, STEPHANIE RAE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RAE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:RAE
Other - Last Name:CARROL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3399 P.G.A. BLVD.
Mailing Address - Street 2:#450
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-366-7772
Mailing Address - Fax:561-798-7700
Practice Address - Street 1:3399 P.G.A. BLVD.
Practice Address - Street 2:#450
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-366-7772
Practice Address - Fax:561-798-7700
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9101160363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA 9101160OtherLICENSE NUMBER